Chapter

 1

Law Enforcement Mental Health and

Wellness Act
Report to Congress
  Chapter  i

Law Enforcement Mental Health and

Wellness Act
Report to Congress March 2019
Recommended citation: Spence, Deborah L., Melissa Fox, Gilbert C. Moore, Sarah Estill, and Nazmia E.A.
Comrie. 2019. Law Enforcement Mental Health and Wellness Act: Report to Congress. Washington, DC: U.S.
Department of Justice.

The Internet references cited in this publication were valid as of the date of publication. Given that URLs and
websites are in constant flux, neither the author(s), the contributor(s), nor the COPS Office can vouch for their
current validity.

The U.S. Department of Justice reserves a royalty-free, nonexclusive, and irrevocable license to reproduce,
publish, or otherwise use the work for Federal Government purposes and to authorize others to do so. This
resource may be freely distributed and used for noncommercial and educational purposes only.
Contents
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Overview of the Law Enforcement Mental Health and Wellness Act . . . . . . . . . . . . . . . 2

Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

U.S. Department of Justice Support for Law Enforcement Mental Health and Wellness 5

Mental Health and Wellness Programs for Military Professionals and Veterans . 7

Is the military a model for law enforcement? . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Public information and wellness promotion campaigns . . . . . . . . . . . . . . . . . . . . . . 9

Embedded mental health professionals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Family readiness and mental health and wellness . . . . . . . . . . . . . . . . . . . . . . . . 12

Expanding support in transition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Suicide prevention policy . . . . . . . . . . . . . . . . . . . . . . . . . 14

The DoD Suicide Event Report . . . . . . . . . . . . . . . . . . . . . . . . . 16

Crisis Hotlines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Findings and limitations: The available data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Veterans Crisis Line and Military Crisis Line . . . . . . . . . . . . . . . . . . . . . . . . . 20

Crisis lines for law enforcement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Mental Health Checks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Approaches . 27

Suggestions for furthering mental health checks in law enforcement . 30

Peer Mentoring Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

Current practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

Obstacles to adoption . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Additional Recommendations to Support the Mental

Health and Wellness of Federal, State, Local, and Tribal Law Enforcement Officers 35

Privacy considerations are key to the success of peer-led programs . . . . . . . . . . . . . . 35

Building resilient officers begins, but does not end, in the academy 37
 i v L AW E N F O R C E M E N T M E N TA L H E A LT H A N D W E L L N E S S A C T

Civilian staff must not be forgotten . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39

Whole health programs are the goal, but there is no single approach
that will succeed everywhere . . . . . . . . . . . . . . . . . . . . . . . . 39

Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

Appendix A. Recommendations . . . . . . . . . . . . . . . 43

Appendix B. Abbreviations, Acronyms, and Initialisms . . . . 45

Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47

Introduction . . . . . . . . . . . . . . . . . . . . . . . 47

U.S. Department of Justice Support for Law Enforcement Mental Health and Wellness . . . . 47

Mental Health and Wellness Programs for Military Professionals and Veterans . 47

Crisis Hotlines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48

Mental Health Checks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48

Peer Mentoring Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48

Additional Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Introduction
Good mental and psychological health is just
as essential as good physical health for law
enforcement officers* to be effective in keeping
our country and our communities safe from crime
and violence. An officer’s mental state affects his
or her behavior in a variety of situations and can
influence decision-making and judgment. However,
the current state of support for officer wellness
nationally is disjointed and faces both cultural and
logistical obstacles.
The daily realities of the job can affect officers’
health and wellness. They face a constant need to
be vigilant, long hours and shift work, exposure to
the daily tragedies of life, and regular interaction
with people who are in crisis or hostile toward
them. Patrol officers face a national undercurrent
of heightened public scrutiny of the profession that
overshadows the legitimacy of their individual efforts.
Corrections officers can expect to encounter verbal
abuse and physical assaults from prisoners and
exposure to hazardous materials and blood-borne
pathogens.1 All of these things added to the ordinary
hassles of the workplace and their personal lives can
lead to cumulative stress and burnout.
Officers anticipate and accept the unique dangers
and pressures of their chosen profession. However,
people under stress find it harder than people not
experiencing stress to connect with others and
regulate their own emotions. They experience
narrowed perception, increased anxiety and
fearfulness, and degraded cognitive abilities.2 This
can be part of a healthy fight-or-flight response, but
it can also lead to significantly greater probabilities
* Throughout this report we refer to law enforcement officers, or “officers,” to be inclusive of sheriffs’ deputies, marshals, special agents, and all the
other individuals who are granted responsibilities for enforcing federal, state, local, or tribal laws and generally engage in the broad range of activities
classified as policing even if the word “officer” does not appear in their job title.
of errors in judgment, compromised performance,
and injuries.3 Failing to address the mental health
and wellness of officers can ultimately undermine
community support for law enforcement and result
in officers being less safe on the job.
Psychological stress may also have serious
consequences for the individual officer’s health.4
In particular, traumatic law enforcement work has
been shown to increase officers’ risk of developing
post-traumatic stress disorder (PTSD) symptoms.5
PTSD is associated with major depression, panic
attacks, phobias, mania, substance abuse, and
increased risk of suicide.6 PTSD can increase the
risk of cardiovascular disease, hypertension, heart
disease, and possibly stroke as well.7
With a professional suicide rate estimated at
28.2/100,000 for men and 12.2/100,000 for
women, officer mental health and wellness needs
to be discussed openly and honestly by the law
enforcement field.8 In releasing his foundation’s report
on first responder suicide in April 2018, Jay Ruderman
said, “We need to end the silence that surrounds the
issue of first responder mental health.”9 This echoes
what we have been hearing from growing numbers
of leaders in the field. With the Law Enforcement
Mental Health and Wellness Act, we believe
Congress has taken an important step in making the
end of that silence a reality. Supporting the expansion
of and access to mental health and wellness services
will help our nation’s more than 800,000 federal,
state, local, and tribal law enforcement officers
identify issues early and get the help they need. And,
most importantly, it will save lives.
 2 L AW E N F O R C E M E N T M E N TA L H E A LT H A N D W E L L N E S S A C T
Overview of the Law Enforcement
Mental Health and Wellness Act
The Law Enforcement Mental Health and Wellness
Act (LEMHWA) was passed in Congress in 2017
and signed into law in January 2018. The fact that
it passed both chambers unanimously and without
amendment shows that its purpose and intended
effects are uncontroversial among policymakers:
Law enforcement agencies need and deserve
support in their ongoing efforts to protect the mental
health and well-being of their employees. But the
timing of the act and this opportunity to respond
to its provisions is important. A damaging national
narrative has emerged in which law enforcement
officers—whether federal, state, local, or tribal—
are seen not as protectors of communities but as
oppressors. Even though there are approximately
800,000 individuals who wear badges in this
country, and they engage in millions of honorable,
positive, and uncontroversial interactions with the
community every day, officers today can find that
their actions are constantly questioned and viewed
suspiciously. The public trust in law enforcement
inherent to successful crime prevention,
suppression, and prosecution can be damaged by
assumptions and misunderstandings as much as
by deliberate challenges and provocations. In this
environment, where an inherently stressful job is
made more so by a constant undercurrent of distrust
and negative public opinion, the risks to officer
wellness are exacerbated.
To aid in addressing these risks, LEMHWA called
for the U.S. Department of Justice (DOJ) to submit
(1) a report to Congress on mental health practices
and services in the U.S. Departments of Defense
(DoD) and Veterans Affairs (VA) that could be
adopted by federal, state, local, or tribal law
enforcement agencies as well as (2) a report
containing recommendations to Congress on
• effectiveness of crisis lines for law enforcement
officers;
• efficacy of annual mental health checks for law
enforcement officers;
• expansion of peer mentoring programs;
• ensuring privacy considerations for these types
of programs.
LEMHWA specified that this work should
include identifying and reviewing research as
well as consulting with state, local, and tribal
law enforcement agencies; the U.S. Department
of Homeland Security (DHS); and other federal
agencies that employ law enforcement officers.
The DOJ is pleased to respond to the act as officer
safety, health, and wellness is a longstanding
priority of the agency. This report addresses these
specific requests of the act in a single document.
The act also specified that the Director of the
Office of Community Oriented Policing Services
(COPS Office) would submit a report to Congress
that “focuses on case studies of programs
designed primarily to address officer psychological
health and well-being.” That report, entitled
Law Enforcement Mental Health and Wellness
Programs: Eleven Case Studies, is periodically
referenced throughout this report, as the case
studies provide examples for many of the points
and recommendations discussed here.
 Introduction  3
Methods
Recognizing the potential linkages between
recommendations for improving officer mental
health and wellness and the case studies of
promising practices in that area, the DOJ tasked
the COPS Office with preparing this report. In
addition to working closely with the authors of
the case studies report to make the best use of
their site visit experiences, the COPS Office team
also reviewed the available literature on mental
health in police officers, crisis lines, peer support
and mentoring, and mental health checks. Publicly
available program information was reviewed from
the DoD, the VA, and a variety of law enforcement
agencies to identify examples and understand
operational context. Contacts within other federal
agencies, national law enforcement stakeholder
organizations, and recognized experts in different
aspects of mental health in law enforcement
agreed to consultation interviews providing their
perspectives and examples. Recommendations
and examples were then presented and discussed
with subject matter experts and knowledgeable
practitioners to ensure their reasonableness
and feasibility.
The end result is that this report first summarizes
some of the existing efforts supported by the
DOJ aimed at promoting mental health and
wellness in law enforcement. It then reviews
some of the programs and efforts of the DoD and
the VA that appear to have the most appeal and
applicability to law enforcement. This is followed by
discussions of crisis lines, mental health checks,
and peer mentoring programs. Recommendations
concerning all these areas are presented
throughout the report as well as summarized in
appendix A to this report.
This report concludes with additional
recommendations that are more global to the
mental health and wellness issue than the
specifically named approaches but that we
believe are important to the design and delivery
of effective services for the men and women who
serve in our nation’s law enforcement agencies
whether at the federal, state, local, or tribal level.
There are differences to be found in some of the
existing services available to members of different
types of departments, and some of the stressors
can be different for federal agents as compared
to tribal officers, city-based officers, sheriffs’
deputies, or state patrol and investigative officers.
But overwhelmingly we found that the similarities
far outweighed the differences. People we spoke
to in agencies with peer support programs
felt there was always room for expansion and
improvement and worried about other agencies
where programs did not exist. The challenges of
trust, system navigation, insurance limitations,
and confidentiality were also cross-cutting. The
lack of geographically proximate behavioral health
professionals is equally significant for employees
of rural sheriffs’ offices and tribal departments as
it is for federal agents assigned in remote field
offices. Suicide threatens officers at all types of
agencies. Consequently, initial plans to specify
recommendations by the type of agency (i.e.,
federal, state, local, or tribal) eventually were set
aside in favor of recommendations that speak to
all of law enforcement. The levels and mechanisms
of support needed to implement these
recommendations may vary depending on the size
and type and location of an agency, but the mental
health and wellness needs of law enforcement
officers—and the types of programs most likely to
meet those needs—do not.
U.S. Department of Justice Support for Law Enforcement
Mental Health and Wellness
The health and safety of all law enforcement
officers, including their mental health and
wellness, is an important priority of the DOJ.
Law enforcement officers do difficult work in
unforgiving conditions; even if most days in
the working life of most patrol officers do not
involve high-speed car chases, ambush by armed
vigilantes, struggles with people made belligerent
by drug use, or other risks to their lives, the fact
remains that any day could involve any of those
dangers or one of many others—and even less
sensational aspects of the job can nevertheless be
stressful and have long-term negative effects on
officers’ mental well-being.
The DOJ recognizes that law enforcement officers
perform uniquely dangerous tasks. It has long
undertaken efforts to promote officer safety, officer
morale, and public respect for their work and has
several programs that translate this support into
action. In 2011, the COPS Office and the Bureau
of Justice Assistance (BJA) formed the national
Officer Safety and Wellness (OSW) Group to
bring attention to the safety and wellness needs
of law enforcement officers following a number
of high-profile ambushes on police. The OSW
Group convenes regularly and brings together law
enforcement practitioners, researchers, and subject
matter experts to help amplify new and existing
efforts to improve officer safety and wellness in the
field. The third of four main themes into which the
OSW Group’s priority areas are organized is mental
and physical health and wellness; the priority areas
under that theme are physical health (e.g., fatigue,
alcohol, weight, and nutrition), maintaining good
health, former military in law enforcement, and—
importantly—psychological health. The OSW Group
meetings in October 2016, October 2017, and April
2018 all dealt with aspects of officers’ mental
health, with the October 2016 meeting focusing on
resilience (specifically in response to mass casualty
events and other major crises) and the October
2017 and April 2018 meetings including in-depth
discussion of emotional health and officer suicide.
The reports on all three of those meetings provide
recommendations of ways agencies can support
their officers’ mental health.10
In addition to cosponsoring the OSW Group,
the COPS Office publishes reports written by
its award recipients whose work involves law
enforcement mental health and wellness. This
library of resources includes reviews of the 2016
Pulse nightclub shooting in Orlando, Florida, and
the ambush of two officers in Las Vegas, Nevada,
in 2014 as well as other events in which the
demands of the job have had the potential to cause
long-standing mental effects on officers.11 After
the massacre at Sandy Hook Elementary School in
2012, the COPS Office partnered with the National
Alliance on Mental Illness to produce a guide for
law enforcement leadership to help equip their
departments for the long-term emotional effects of
such critical incidents.12
Similarly, the BJA’s efforts extend beyond the OSW
Group. The Officer Robert Wilson III Preventing
Violence Against Law Enforcement Officers and
Ensuring Officer Resilience and Survivability
(VALOR) Initiative is a collection of programs
providing training, research, partnerships, and other
resources to benefit law enforcement officers’ short-
and long-term safety, wellness, and resilience. The
suite of programs in the VALOR Initiative includes
training and technical assistance programs on de-
escalation strategies and tactics, crisis intervention
training, and other physical safety concepts, as well
as research and programs on resilience and other
 6 L AW E N F O R C E M E N T M E N TA L H E A LT H A N D W E L L N E S S A C T
mental health and wellness concepts.13 In 2018, BJA
also launched the National Officer Safety Initiative
in support of the President’s February 9, 2017,
officer safety–focused executive order. This BJA
National Officer Safety Initiatives program is funding
innovative approaches to augment law enforcement
safety in three key areas: (1) law enforcement
suicide, (2) traffic safety, and (3) a national public
awareness and education campaign.
For many years the BJA has administered two
programs important to officer safety and wellness:
(1) the Public Safety Officers’ Benefits (PSOB)
program and (2) the Bulletproof Vest Partnership
(BVP). The PSOB program provides a death benefit
to the eligible survivors of federal, state, or local
public safety officers. It also provides a disability
benefit to eligible public safety officers who have
been permanently and totally disabled as the direct
result of a catastrophic personal injury sustained
in the line of duty.14 Since its inception in 1976,
the PSOB program has provided more than $1.8
billion in these death and disability benefits to law
enforcement officers, first responders, and their
families. The BVP has assisted state and local
agencies in purchasing more than one million vests
since it was created in 1998.15
Other components provide mental health support
and services to law enforcement officers as
well. The Office for Victims of Crime’s online
resource, the Vicarious Trauma Toolkit, “was
developed on the premise that exposure to
the traumatic experiences of other people”—
survivors of terrorism and mass violence, as
well as their families; people who have been
physically or sexually abused or subject to
human trafficking; even first responders—“is an
inevitable occupational challenge for the fields
of victim services, emergency medical services,
fire services, law enforcement, and other allied
professionals.”16 The toolkit offers guidance in
assessing agencies’ readiness to cope with
vicarious trauma; prioritizing needs, making
plans, and identifying resources to help agencies
become trauma-informed; and developing policies,
procedures, and programs to strengthen agencies’
response to vicarious trauma.
The National Institute of Justice funds dozens of
projects on officer safety—as of September 5, 2018,
there are 23 open awards accounting for close to
$12 million, of which about one-third of the awards
(and more than half the funds—eight awards worth
more than $6 million) specifically focus on officer
stress, resilience, or mental well-being and a ninth
almost million-dollar award is a multilevel study on
officer safety and wellness in general.17
But even with these programs and projects in
place, gaps still remain—which is why Congress
has charged the DOJ with investigating other ways
to make stronger government support for law
enforcement mental health and wellness a reality.
Mental Health and Wellness Programs for Military
Professionals and Veterans
Section 1(a) of LEMHWA requires that this report
examine DoD and VA mental health practices
and services that could be adopted by federal,
state, local, or tribal law enforcement agencies.
The precedent for looking to the armed services
for examples of programs to serve the law
enforcement professions is well established; there
are similarities in the structure of organizations,
in the round-the-clock functions, in the exposure
to life and death situations, and in the cultural
intertwining of personal and professional identity.
Both military and law enforcement professionals
hold ranks, carry weapons, and are trained to use
deadly force. We expect them all to run toward
danger, not away from it, to face some of the
most horrific circumstances imaginable while
remaining calm and rational, and to work to restore
order from chaos. Courage, valor, honor—these
are important words in both professional worlds,
telling us as much about the values they hold for
themselves as about those we hold them to.
But while the paramilitary nature of law
enforcement agencies and the hypervigilant
environment in which they work are no doubt
some of the primary reasons why parallels are
often drawn between the two professions, the
composition of the respective workforces is also an
important consideration when looking for ways to
promote and preserve the mental wellness of the
law enforcement organization.
According to the Bureau of Labor Statistics,
the overall labor force in the United States is
approximately 53 percent male with an average
age of 42. Law Enforcement Management and
Statistics data from the Bureau of Justice Statistics
show that the composition differs in local law
enforcement, where about 87 percent of those
employed in the industry are men, and the average
age is 39. DoD statistics show that the active duty
and reserve workforce is more similar to that of
law enforcement than the general population, with
men accounting for approximately 83 percent of
the workforce and an overall average age of 34.
Why might these demographics matter? Consider
suicide rates: Men are 3.5 times more likely to
commit suicide than women, and one of the
highest suicide rates is for middle-aged men.18
Policing and the military professions are both
reported to experience suicide at rates higher than
the general population. Whether the higher suicide
rate is due to the fact that these professions
employ significantly higher percentages of
men or whether middle-aged men are at higher
risk of suicide because they are more likely to
work in these types of high stress and high risk
professions is not for this report to determine.
But the commonality of male-majority workforces
is significant because to the extent they are
interested in promoting wellness and help-seeking
behaviors among employees, they will face some
gender-related challenges. A number of studies
over the years have found that men pursue
preventive screenings, maintain a regular source
of care, and get timely medical interventions much
less often than women.19
This tendency is not because men are somehow
programmed to avoid seeking help. But some
research has suggested that “men who score
higher on measures assessing dimensions of
masculinity norms generally have less favorable
 8 L AW E N F O R C E M E N T M E N TA L H E A LT H A N D W E L L N E S S A C T
help-seeking attitude, seek help for psychological
problems less often, and in some cases fail to
obtain routine health examinations.”20 While the
reasons behind this gender difference are not
fully understood, research indicates that men
who more strongly identify with masculine norms
tend to show poorer mental health and less
psychological help seeking.21 In addition, studies
have found that a prominent socially accepted
role for men includes the notion that need for
help and perceived weakness are not congruent
with masculinity.22 Put another way, cultural
expectations of male behavior, often valued by both
the military and law enforcement professions, can
be among the main barriers to ensuring not only
that there are programs and services to address
the unique health and wellness needs of a largely
male workforce but also that those programs and
services are accessed and used by that workforce.
An additional concern, unique to this population, is
that seeking assistance can jeopardize an officer’s
career—that they may be taken off the street or
forced to turn in their weapon—which is another
important challenge to help-seeking behavior in law
enforcement.
While both professions are predominantly male,
there are growing numbers of women serving both
in the military and in law enforcement. Research
supports the need for greater awareness of sex-
specific mental health needs as well as more
definitive studies to further address these needs in
the context of sex-specific treatment approaches.†
Is the military a model for law
enforcement?
There are reasons why so many people in the law
enforcement arena may look to the military for ideas,
models, and programs to improve officer mental
health and wellness. To the extent that the DoD and
the VA have identified ways to encourage help-
seeking behavior and provide services that recognize
†
More research is needed regarding the impact of increasing workforce diversity and gender balance on wellness, help-seeking behaviors, and
treatment and intervention effects in law enforcement work environments.
the unique challenges facing the workforce, the
law enforcement community should absolutely
look to learn from those efforts. But it should do so
recognizing that the DoD and the VA working across
the nation with their public and private partners still
have room to improve their own efforts to support
service member and veteran mental health and
wellness—as evidenced by a suicide rate higher
than the general population’s—and that not every
program they have implemented has been proven
effective. Every death by suicide is a tragedy, and
as long as there are deaths by suicide, efforts to
prevent suicide must continue.
There are also ways in which the two professions
are not so neatly comparable, particularly when
it comes to their ability to implement wellness
programs. The military ultimately has a single
employer. All health services both for active duty and
retired service members are centralized. While the
individual experience of ease of access and quality
can vary, the development and implementation of
wellness programs can be rolled out on a national
scale to all employees and retirees. The Defense
Health Agency (DHA) is the joint, integrated
Combat Support Agency that “supports the
delivery of integrated, affordable, and high quality
health services to Military Health System (MHS)
beneficiaries and is responsible for driving greater
integration of clinical and business processes across
the MHS.”23 DHA directs the execution of multiple
shared services across the service branches
including pharmacy, health information technology,
education and training, and public health. DHA
also administers the TRICARE Health Plan, which
provides medical, dental, and pharmacy programs to
more than 9.4 million uniformed service members,
retirees, and their families.
In policing, there are more than 17,000 agencies in
the United States with a wide variety of benefits
plans and providers, a variety of affinity groups and
labor organizations, and no agency exists to
 Mental Health and Wellness Programs for Military Professionals and Veterans  9
serve the unique health and wellness needs of law
enforcement retirees. Furthermore, nearly half of
those law enforcement agencies employ fewer
than 10 full-time sworn officers.24 Although most of
the approximately 800,000 officers in this country
work for larger agencies—63 percent of officers
work for one of the 5 percent of agencies that
employ more than 100 sworn25—even a large police
department in this country is small when thinking
of them as organizations providing a complex series
of training and services to their employees. Only
43 local police departments in the Unites States
have more than 1,000 sworn employees. The total
number of military personnel (active duty and
reserve) is nearly 3.5 million. The DoD and the VA
have the ability to support and deploy large-scale,
multifaceted, health and wellness programs in a
way that most law enforcement agencies do not.
With this basic understanding of why DoD programs
may hold promise as models for addressing the
unique needs of law enforcement personnel but
nevertheless not be plug-and-play replicable, we can
look at some DoD and VA resources and programs.
The focus in this report is not to comprehensively
catalog everything they have to offer in terms
of mental health and wellness, but to focus on
approaches that seem to offer not just the most
applicability to the law enforcement context,
but also the potential for replicability in a highly
decentralized professional environment.
We therefore attempt to stay away from programs
and services that are the most integrated with
the structure of the DoD as a centralized health
care provider with enforceable fitness-for-duty
standards because the inability to replicate across
50 states and thousands of cities and counties
with different health care provider networks and
collective bargaining agreements would likely
make replication unsuccessful. For example, policy
updates to TRICARE ended limits on the number
of annual visits covered individuals could use for
various mental health services. Insurance limits
on mental health services is often reported as a
major barrier to accessing services or completing
treatment plans by law enforcement officers.
For another example, this report will later look at
the idea of annual mental health checks in law
enforcement—but if we simplistically present
the DoD’s predeployment readiness screens
as potential models for law enforcement, we
overlook the importance of the DHA infrastructure
in the design and administration of the program
as well as overlooking the important differences
between daily police work and sustained military
deployments to duty stations far removed from
home and civilian life.
Public information and wellness
promotion campaigns
Spend any time looking at Military OneSource, or
the Defense Suicide Prevention Office website,
or the MHS site, or Crisis Line pages, or many
of defense community news sites for service
members and their families, and it becomes
apparent just how much public information
the DoD promotes to encourage help seeking
behavior. Promotional campaigns, resource guides,
social media feeds, news stories, all work to
destigmatize and demystify mental health services
and ensure service members that providers in
their communities are familiar with the challenges
of military life. Promotional efforts are expanded
when they can build on other national-level
initiatives, such as during National Mental Health
Month or National Suicide Prevention Week,
amplifying the broader public health efforts around
mental wellness with military specific information.
For example, the MHS runs Operation Live
Well. First launched in 2013, it takes a holistic
approach to helping military families live their
best. It provides information and resources in
integrative wellness, mental wellness, nutrition,
physical activity, sleep, and tobacco-free living.
 1 0 L AW E N F O R C E M E N T M E N TA L H E A LT H A N D W E L L N E S S A C T
Its information is designed to make healthy living
an easier option for service members by being
informed by the service member experience.
At the time the multiyear, multiphase effort was
launched, the DoD estimated that in a single year,
the military discharged more than 1,200 first-
term enlistees before their contracts were up
because of weight problems and that TRICARE
was spending more than $1 billion per year on
obesity-related medical costs.26 Its whole health,
whole family approach recognizes that our physical
and mental well-being are interrelated, that our
environments can make it easier or harder to be
healthy, and that good information on health and
fitness needs to be presented to communities
in ways that recognize the complexities of their
lives—particularly when dealing with the unique
aspects of life in the military community.
Comprehensive mental health promotion may be
similarly beneficial. One interview subject spoke
about work he had read by Dr. Michael Matthews,
Professor of Engineering Psychology at the United
States Military Academy, that had influenced
his thinking in recent years. In his 2014 book,
Head Strong: How Psychology is Revolutionizing
War,27 Dr. Matthews explores how a change in
perspective—going from a reactive, disease-based
health care model to a proactive, prevention-
based health and wellness model—can make an
immediate difference in operational readiness. And
that training in prevention is not just for building
a stronger and more ready military but also the
route to improving the operational readiness of
all first responders. The interviewee believed that
there should also be a corresponding savings in
health care cost related to reducing or eliminating
chronic health problems associated with the
daily exposure to stress—such as PTSD, anxiety,
hypertension, and other metabolic diseases—in
the emergency services.
DoD and VA resources include easy-to-find
materials on what to expect at a first appointment
with a behavioral health provider, how to talk to a
medical provider about mental wellness concerns,
and how to recognize risks in family members and
peers and what to do when you see them. They
also provide smartphone apps for self-care like
Virtual Hope Box (VHB), which is modeled on a
cognitive behavioral therapy technique that uses a
physical box containing things that remind patients
of positive experiences, reasons for living, people
who care about them, or coping resources. A
recent study found that the smartphone app was
more effective than print materials at improving
veterans’ ability to cope with unpleasant emotions
and thoughts. The authors of the study concluded
that the VHB may be an important way to improve
patient coping by making an existing cognitive
behavioral therapy technique more convenient
and accessible.28
And they produce resources aimed at helping the
civilian clinician community better understand the
unique needs of service members and veterans.
For example, the VA produced a Community
Provider Toolkit on suicide prevention with
information on assessment, safety planning, VA
resources, education, and other tools a community-
based care provider might need to know to help a
client at risk who is a veteran.
Recommendation 1. Support the creation of a public
service campaign around law enforcement officer
mental health and wellness in conjunction with National
Mental Health Month.
The law enforcement community is only just
beginning to talk about mental health and wellness.
Support is needed to develop national campaigns
about the risks and opportunities to officer mental
health that can be deployed in conjunction with key
national public health initiatives. One of the biggest
barriers to seeking help is fear of the unknown or a
sense that there is no one who can help. Reinforcing
the already existing public message that there is
help with law enforcement–specific messages that
acknowledge the community’s unique needs can
Mental Health and Wellness Programs for Military Professionals and Veterans
help officers and agencies talk about those needs.
National campaign material can then be customized
by agencies with wellness programs to include
resources on programs and services they offer.
Recommendation 2. Support the development of
resources for community-based clinicians who interact
with law enforcement and their families to help them
better understand some of the unique risks facing their
clients and what resources may be available to them as
members of the first responder community.
Encouraging officers to seek help is only half
the equation. No public campaign will succeed
if they cannot access quality clinical support that
understands the profession. Evidence-based web
and electronic toolkits of resources and safety plan
quick guides that introduce clinicians to some of
the unique realities of law enforcement should
be developed. Congress already recognized this
need in part in section 3 of LEMHWA when it
directed the Attorney General and the Secretary
of Health and Human Services to partner in
producing law enforcement–specific resources
for clinicians and behavioral health providers. But
the development of clinician training and toolkits
of provider resources—including the identification
of referral networks, family support options, and
locality-specific information in connection with
support for growing the network of embedded
professionals—would help further extend the reach
of informed clinicians, particularly in more rural
or isolated parts of the country where there may
not be an extensive clinical network of providers.
Existing comprehensive wellness programs in law
enforcement agencies, like those profiled in the
wellness case studies report, as well as clinicians
who have direct law enforcement experience and
the community of police psychologists could all
be tapped to build a national-level evidence-based
toolkit in cooperation with the DOJ.
11
Embedded mental health professionals
It can be difficult to convince anyone in need of help
to make the effort to seek it. Finding mental health
professionals who can be trusted and are perceived
as beneficial can be tough for anyone, not just
service members or law enforcement officers. So
finding ways to make access easy and convenient
is important. The DoD runs a variety of efforts
to expand access and use, including producing
extensive resources on how to find a provider that
will work for you and what to expect when calling
a crisis line or meeting with a behavioral health
professional through the TRICARE network.
One of the ways the DoD is attempting to improve
access is by embedding services and providers
with the service members. Madigan Army Medical
Center, which is located on Joint Base Lewis-
McChord just outside Lakewood, Washington,
offers all behavioral health service line programs
in-house. Outpatient and inpatient care, substance
abuse treatment, family advocacy, child and family
care, support for traumatic brain injuries—all are
available through what they are calling embedded
behavioral health (EBH) teams.
EBH teams are in the unit areas. Service
members therefore spend less time travelling to
appointments; also, the teams’ being embedded in
operational units helps remove some of the stigma
around their use. The teams also work to build a
working relationship with unit commanders so that
they can be informed on generalized trends across
units, like with sleep or leadership stressors. In
an article published early in 2018, the lieutenant
colonel who serves as the chief of behavioral
health at Madigan observed that with the EBH
teams in place, soldiers “are willing to come in and
get care . . . they realize they can go get care and
not be treated as broken.”29
12 L AW E N F O R C E M E N T M E N TA L H E A LT H A N D W E L L N E S S A C T
The integration of clinicians with the unit also helps
in explaining to soldiers that seeking care is highly
unlikely to impact their careers. There are very few
diagnoses that are career limiting, and command is
seldom aware of who is receiving care.
Recommendation 3. Support programs to embed
mental health professionals in law enforcement
agencies.
It is clear from a variety of DoD programs that it is
important to military personnel that programs and
services be culturally competent to the military
experience. This is the experience in first responder
communities as well—law enforcement officers
want the people they talk to to understand the job
and the unique stresses it can place on them. While
some people will enter a career in behavioral health
after spending time as a sworn law enforcement
officer, there will never be enough to provide care to
all the law enforcement officers in the country. Also,
ease of access is important to encouraging use.
But a program that embeds behavioral health
practitioners into law enforcement agencies even
part time could not only reduce barriers to use
but could also help expand the understanding
of mental health professionals in terms of the
unique risks and experiences of law enforcement.
Examples of this already exist in a number of
police departments with physicians who act as
medical directors, often attached to specialty
units like special weapons and tactics (SWAT). In
some agencies licensed physicians are also sworn
reserve officers, bringing them into the culture and
climate of the department where they get to know
the officers alongside whom they serve. Even if
primary medical care is not their job purpose in the
department, they can be a resource for officers
with questions, help demystify the system of
medical care locally, and assist departments in
vetting the services of other medical specialists for
the ability to work with the unique population and
in a unique environment.
Mental health professionals could also be
integrated into agencies through reserve officer
programs or through memoranda of understanding,
retainers, or other flexible arrangements. While
not every agency can support its own exclusive
police physician, there may be ways to support
the expansion of police physician programs on a
regional sharing basis and similarly encourage the
building of programs to embed police behavioral
health providers into departments as well.
Family readiness and mental health and
wellness
For anyone, either the home can be the place where
they find the strength to manage the stress of their
job or it can be the source of stress that makes the
job more challenging. This is particularly true for
service members and law enforcement officers. In
many respects, military families also serve—not just
the uniformed individual. There are unique stresses
to being the family of a service member, and the
DoD has built extensive programs over the years to
assist families. Helping the family be healthy and well
is part of making sure the service member is also.
Family readiness programs are built on the premise
that knowing that a spouse will have the support they
need while the service member is deployed will help
the service member stay mission-focused.
Family readiness groups (FRG) are the long­
standing focal point of family readiness in the U.S.
Army and Navy. In the Air Force, it is known as the
Key Spouse program; the Marine Corps has the
Family Readiness Program; and the Coast Guard
has the Work-Life Program. But what all these
programs do is keep spouses and families informed
and supported during a service member’s time with
a unit, especially during that unit’s deployment.
The FRGs all operate slightly differently by branch
of service, but they are key sources of information
to unit families and strive to make family members
feel as resilient and connected to the broader
support community as possible.
 Mental Health and Wellness Programs for Military Professionals and Veterans  1 3
The DoD also supports broader programs aimed
at spouse and family member resiliency, not just
during deployments but also when they return
and are managing the day-to-day realities of
military life like periodic moves, which can make
it challenging for spouses to maintain careers
and lead to children struggling with changing
schools. Research has shown that military
spouses and children experience higher levels
of depression and anxiety than the general
population.30 Extensive resources for parents are
available through Military OneSource.
Recommendation 4. Support programs for law
enforcement family readiness at the federal, state, and
local level.
When law enforcement officers are asked about
the major stressors in their lives, family worries
are always near the top of the list. They know
their families fear for them on the job, and that
can make it hard for them to fully share their
experiences with their families in ways that
might benefit their own mental wellness. The
24/7 nature of the job, shift work, exposure to
traumas that they wish to protect their own loved
ones from—all of these things can make it hard
for law enforcement families to understand and
support their officers. Furthermore, unlike service
members on deployment, law enforcement officers
are “deployed” in their own communities. In
natural disasters or civic emergencies, the stress
of ensuring their own families’ safety can be an
additional emotional burden that affects their ability
to stay mission-focused. In short, law enforcement
families also serve, just as military families do, and
it is important to provide them with both education
and counseling services to help the whole family.
Some agencies and organizations have begun to
spend more time on supporting the whole officer
family, but the effort is nascent. Most family support
programs, whether local or national, primarily focus
on the survivors of fallen officers. The COPS Office
is taking a first step toward better informing future
expansion efforts with a project it funded in FY
2018 for the International Association of Chiefs of
Police to develop resources on supporting officer
families, including a guidebook on integrating family-
friendly policies into a department, blog posts, a
podcast series, and a brochure on starting family
support groups. To shed more light on this important
resiliency factor, support is needed in three key
areas: (1) to more fully explore the stressors that
law enforcement families experience; (2) to create
educational programs that help families recognize
and acknowledge when they may need professional
assistance and where and how to get that
assistance; and (3) to build more comprehensive
family readiness programs, whether through national
organizations or at the individual agency level.
Expanding support in transition
The coordination of DHA and VA programs and
services is one of the ways the DoD is able
to provide care to many transitioning service
members and retirees in a way that would be
beyond the capability of law enforcement agencies.
But even then the system is not a complete
guarantee. In January 2018, President Trump signed
an executive order, “Supporting Our Veterans
During their Transition From Uniformed Service to
Civilian Life,” which directed the DoD, the VA, and
the DHS to develop a joint action plan ensuring
that the new veterans who did not qualify for VA
healthcare would receive treatment and access
to services for mental health care for one year
following their separation from service.
At the time the executive order was signed, it was
noted by the U.S. Secretary of Veterans Affairs that
service members in transition to veteran status
face higher risks of suicide and mental health
issues than active-duty members. In addition to
working to expand mental health programs to
new veterans and eliminating prior time limits, the
 1 4 L AW E N F O R C E M E N T M E N TA L H E A LT H A N D W E L L N E S S A C T
three departments also announced plans to extend
Military OneSource to veterans in the first year
following separation.
Military OneSource offers a wide range of
individualized consultations, coaching, and
counseling for many aspects of military life.
Its programs are available at no cost to service
members whether active duty, reserve, or National
Guard; their families and survivors; and the recently
separated. The services are all encompassing, from
nonmedical counseling to assistance with elder
care, adoption, education, spousal employment,
relocation tools, and even tax preparation
services. It also gives users confidence that all the
information it provides through its web portal and
call center have been vetted by the DoD.
Recommendation 5. Encourage departments to
allow retired law enforcement officers to make use of
departmental peer support programs for a select period
of time post-retirement or separation.
The memories of traumatic incidents and the
impacts of a career composed of high-level stress
do not automatically dissipate when officers leave
the job.
Taking a page out of the recent executive order
expanding the use of Military OneSource to recent
separations, law enforcement agencies with peer
support programs could make those services
available to recently retired officers for a period of
time. The transition to retirement can be a critical
time for law enforcement, particularly considering
that they often retire many years ahead of their
non–law enforcement peers. A sudden separation
from the peer networks that help make the job
manageable puts retirees at risk for depression,
and given research that shows officers on average
live significantly shorter lives than non-officers,31
more needs to be done to support the transition
to retirement.
In fact, many peer support programs in law
enforcement agencies are run and staffed by retirees.
In the wellness case studies report, the authors
found that those staff and volunteers value the
chance to give back to the profession and to continue
to serve other officers. But for those new retirees
who are not looking for volunteer service, being able
to access their agency’s wellness networks and
services that helped them while they were on the
job could be an important benefit to extend into the
transition to retirement or second careers.
Suicide prevention policy
Mental health and wellness is more than
just suicide prevention, but given the higher
suicide rates found in both the military and law
enforcement environments than in the general
population, it is important to note that the DoD has
made substantial investments in the area of suicide
prevention. The investment in recognizing the
extent of the problem places them ahead of the
law enforcement profession in prevention efforts.
In November 2017, the Office of the Under
Secretary of Defense for Personnel and Readiness
issued DoD Instruction 6490.16,32 which
established policies and assigned responsibilities
for the Defense Suicide Prevention Program,
incorporating earlier directives into a single
issuance. It begins with an overview of DoD policy
regarding suicide prevention:
“It is DoD policy that the DoD:
a. Make substantial efforts to reduce suicide.
 Mental Health and Wellness Programs for Military Professionals and Veterans  1 5
b. Foster a command climate that:
(1) Encourages personnel to seek help and
build resilience.
(2) Increases awareness about behavioral
healthcare and reduces the stigma
for personnel who seek behavioral
healthcare, in accordance with DoD
Instruction (DoDI) 6490.08.
(3) Protects the privacy of personnel
seeking or receiving treatment relating
to suicidal behavior, consistent with
applicable standards, including DoD
5400.11-R, DoD 6025.18-R, and DoDI
6490.08. This includes data collected
over the course of suicide prevention,
intervention, and postvention activities.
c. Provide personnel continuous access to
quality behavioral healthcare and other
supportive services, including crisis
services; foster collaboration of DoD
suicide prevention efforts; and services to
strengthen readiness and resilience of DoD
personnel and their dependents.
d. Provide DoD Components with a training
competency framework on suicide
prevention.
e. Develop program standards and critical
procedures for suicide prevention,
intervention, and postvention that reflect a
holistic approach.
f. Collect and consolidate surveillance data of
suicides and suicide attempts for reporting
and analysis for members of Active
Component and SELRES, and for suicides
by Service members’ dependents using
consistent collection, reporting, and analysis
of suicides and suicide attempts. This
includes suicide-related behaviors data from
the Department of Defense Suicide Event
Report (DoDSER) submitted by the DoD
Components in a timely manner to support
suicide prevention efforts.
g. Promote lethal means access measures
for suicide prevention, in accordance with
Section 3 of this issuance.
h. Encourage unit memorial ceremonies and
services when a Service member dies by
suicide.
i. Implement the Department of Defense
Strategy for Suicide Prevention (DSSP),
which is modeled after the National Strategy
for Suicide Prevention and encompasses
the comprehensive policy on prevention
of suicide among Service members, as
required by Section 582 of PL 112-239.
j. Foster collaboration, cooperation, and
coordination among stakeholders, including
other federal agencies; appropriate public,
private, and international entities; and
appropriate institutions of higher education
to support suicide prevention policies and
programs in accordance with Section 591 of
PL 114-92.”33
Recommendation 6. Support the development of
model policies and implementation guidance for law
enforcement agencies to make substantial efforts to
reduce suicide.
Policy on its own, of course, does not mean anything
without practical implementation. But policy is an
important starting place. Policies not only tell us
the operational standards of agencies but also are
statements on what is important and valued.
The introductory language of the DoD instruction
on suicide prevention offers a starting point
because a law enforcement agency of any size
could establish a policy that fosters a climate
that encourages personnel to seek help, builds
 1 6 L AW E N F O R C E M E N T M E N TA L H E A LT H A N D W E L L N E S S A C T
resilience, and reduces stigma around behavioral
healthcare. In fact, the statement of intent captured
in policy could play an important role in changing
the climate within an agency by demonstrating that
the mental health of its personnel and help-seeking
behavior is valued.
Other sections of the DoD guidance may also
offer potential models for basic law enforcement
policy development at the agency level, including
on the protection of privacy for individuals making
use of intervention and support services. Also the
case studies on law enforcement mental health
and wellness conducted under the auspices of the
LEMHWA offer some examples of agencies with
established programs that have incorporated some
aspects of operations into departmental policy,
most often around information privacy.
But a systematic effort to develop model policies
and implementation guidance could include a more
comprehensive review of what currently exists, how
pieces from different experiences could fit together,
and how it could vary from federal law enforcement
agencies to smaller local and tribal departments.
It could also include other suicide prevention
experts in the discussion, particularly those who
have worked with first responders and military
personnel. Model policy development should also
look at issues regarding data collection, retention,
and privacy and what agencies can protect versus
what they must share with the public about suicide
prevention and other wellness efforts. Consideration
must also be given to how agencies memorialize
employees who die by suicide.34
The DoD Suicide Event Report
The annual DoD Suicide Event Report (DoDSER),
first published in 2007, is the principal suicide
surveillance tool of the DoD and an important
data point in the DoD’s efforts to prevent future
suicides. Without accurate, detailed, and timely
information on suicides and suicide attempts,
prevention and postvention programs are less
likely to be effective and any evaluation of program
effectiveness is impossible.
The DoDSER reports on the contextual factors
of suicides and attempts by service members,
including event circumstances, medical and
behavioral health factors, job-related factors,
lifestyle stressors, and demographics. In all more
than 500 data elements are a part of the survey.
This type of detailed information, even with all
personally identifiable information redacted, is
invaluable to those in the organization charged
with designing and evaluating the DoD’s suicide
prevention programs, policies, and strategies.
As was stated in a forum of police leaders on
the topic of law enforcement suicide several
years ago, “we cannot prevent that which we do
not acknowledge.”35 In addition to transparently
acknowledging the problem of service member
suicide, the DoDSER provides a relatively
comprehensive picture of the problem across
the service branches and allows the DoD to
look for common risk factors and patterns that
may be mitigatable.
The 2016 report was released in June of 2018.
In light of the earlier discussion on how men are
less likely to engage in help-seeking behaviors,
it is interesting to note that one of their findings
was that “communication of suicidal thoughts and
feelings [was] either not made or [not] recognized
in 64.9 percent of suicide cases.”36 Another
important finding is that “firearms were the
method of injury most often identified in suicide
cases (62.2 percent). The majority (94.6 percent) of
the firearms used were personal possessions, with
only 3.8 percent of firearm deaths resulting from
self-directed use of a military-issued weapon.”37
Other findings include the fact that nearly half of
those who died by suicide had at least one current
or past behavioral health diagnosis, and substance
abuse and anxiety were among the most common.
 Mental Health and Wellness Programs for Military Professionals and Veterans  1 7
Also interesting is that for both suicides and suicide
attempts, a majority of the individuals had had
contact with the MHS in the 90 days prior to
the incident.
These are examples of the types of contextual
information that is critically important to
organizational efforts to improve wellness and
prevent suicides. If a high percentage of the cases
involved near-term contact with the health system
prior to the incident, were there opportunities to
intervene? If in two-thirds of cases there were no
identifiable help-seeking behaviors noted, is that
because the individual really hid it well or because
the wider community lacks training and awareness
on the signs of suicide and what to do if you see
those signs in someone you know?
The Veterans Crisis Line (VCL, discussed further
in Crisis Hotlines beginning on page 19) provides
information on warning signs of suicide that
everyone should be aware of including the
following:
• Anxiety, agitation, sleeplessness, or mood
swings
• Feeling excessive guilt, shame, or sense of
failure
• Engaging in risky activities without thinking
• Increasing alcohol or drug misuse
• Neglecting personal welfare
• Deteriorating physical appearance
• Withdrawing from family and friends
• Showing violent behavior, like punching a hole in
the wall or getting into fights
• Giving away prized possessions38
Recommendation 7. Support the creation of a
Law Enforcement Suicide Event Report surveillance
system, possibly beginning with a focus on federal law
enforcement agencies.
Since the DOJ established the National OSW
Group in 2011, the issue of law enforcement
suicide has repeatedly come up in discussions,
always noting that we in fact know very little about
the circumstances of law enforcement suicide
or even the number that take place each year.
A number of reasons why this is the case have
been discussed in law enforcement circles over
the years, and although general cultural reluctance
to acknowledge suicides is a part of it, efforts to
protect the survivors also become a factor—death
by suicide can lead to a loss of survivor benefits or
the denial of funeral honors. Agencies that do not
want to hurt the survivors further can therefore be
incentivized to remain silent about suicides.
But even for agencies that acknowledge suicides,
an unintentional misclassification as an accidental
or undetermined death is still possible, and we
understand very little of the causes. There is
no widespread, systematic effort to look at law
enforcement suicides and their circumstances the
way there is about line-of-duty deaths through the
FBI’s LEOKA (Law Enforcement Officers Killed
and Assaulted) program and the National Law
Enforcement Officers Memorial Fund’s (NLEOMF)
analysis efforts. Two small nonprofits, the Badge
of Life and Blue HELP, provide some of the best
estimates we have of the number of suicides in
law enforcement each year, and they consistently
show them exceeding line-of-duty deaths.
Furthermore, we have seen recently that suicides
are not always isolated events, and once there is
one suicide in an agency others may follow. For
example, at the time of this writing, the Chicago
Police Department had experienced four suicides
 1 8 L AW E N F O R C E M E N T M E N TA L H E A LT H A N D W E L L N E S S A C T
in four months.39 Questions about whether
these stories are tragic coincidences or clusters
of evidence of systemic risk factors cannot be
answered without more rigorous data collection
and research efforts.
The creation of a law enforcement suicide event
report surveillance system modeled on the DoDSER
is critically needed to understand suicide in law
enforcement. Any data collected must also be
analyzed to inform prevention, training, and practice.
Are there officer job assignments that are riskier
than others? Discernable patterns in age, tenure, or
experience? Guessing what the risks and barriers
are is no substitute for rigorous research. Research
partnerships with public health or academic
organizations may provide the analytic capabilities
needed to support the data collection efforts.
In recognition of the complexity of collecting,
managing, and analyzing these data, as of 2018
Badge of Life is no longer making their statistics
public and is instead “promoting the mandatory
reporting of all suicides by chief law enforcement
executives into a national repository.”40
Recognizing that collecting sufficiently detailed
information across thousands of agencies would
be an incredibly challenging task, one way to
begin would be with the creation of a federal law
enforcement suicide event report, bringing together
data on suicides and suicide attempts from the
DOJ, the DHS, and other federal agencies with
sworn officers. Although federal law enforcement
work is recognizably different than that of much
state and local work, the problem of suicide in the
workforce is known to be there as well. In addition
to providing valuable information to the federal law
enforcement agencies on how to better protect
their own officers, a multiyear surveillance of the
federal agency experience could provide insights
into risks in state, local, and tribal agencies.
Crisis Hotlines
There is no large-scale academic evidence for
the efficacy of crisis lines‡ for the mental health
and wellness of law enforcement personnel. In
addition, the efficacy of crisis hotlines in preventing
suicides has not yet been empirically proven for
the general population. However, it is the opinion
of our interviewees that, in spite of the need for
deeper research, crisis lines are an important tool
for addressing mental health generally and suicide
specifically for law enforcement officers. It is
important to note that while crisis lines address
any number of mental health scenarios, most
of the research centers on suicide and suicidal
ideation and so this discussion will also necessarily
center on suicide. Our interviewees stressed
that while suicide prevention is of paramount
importance, it is critical to ensure that officers have
access to services far before reaching the point of
suicidal ideation. As one interviewee said, “If they
are already at that point, just keep them away from
a weapon.” Crisis lines may be a uniquely effective
tool at one point of intervention, but mental health
services ought to be comprehensive and ongoing.
“We need to provide mental health care as primary
care,” said one federal interviewee, “not simply
reactive care.”
Findings and limitations:
The available data
Proving that a suicide has been prevented is
difficult to measure in an academically rigorous
fashion, partly because it is nearly impossible to
create a randomized trial and partly because privacy
concerns can inhibit follow-up calls or pre- or post-
testing. Furthermore, there may be a population
‡ This report uses “crisis lines” broadly to refer to any type of always-available service people feeling troubled can contact for advice and referral,
including what may be called hotlines, helplines, live chat, text, suicide prevention lines, and so on.
self-selection problem: Those who reach out to
a crisis line may be less disposed to self-harm or
may be more desirous of being talked down from
suicidal ideation. It is even more difficult to prove
efficacy for prevention of self-harm or harm that
does not reach the threshold for suicidal ideation.
While any comprehensive attempt to address
officer mental health and wellness must be far
broader in scope than suicide prevention, most
research on crisis lines involves suicidal ideation
and includes metrics concerning suicide. It remains
unclear if law enforcement employees are at special
risk for suicide, but we do know that the success
rate for suicide by firearm is the highest of any
suicide method (82.5 percent of suicides attempted
with a firearm are successful).41 Because officers
have ready access to firearms, the risk of success
is potentially much higher. Therefore, officers must
have equally ready access to crisis counselors at all
times. Crisis hotlines offer an opportune solution to
the acute crisis of suicidal ideation.
The available research shows that responders at
crisis lines can reduce distress over the course
of a call for both suicidal42 and nonsuicidal crisis
callers.43 A study of a national general population
crisis line found that half of callers reported seeking
additional care after reaching out to a crisis line in
follow-up calls.44 Similarly, the VA’s suicide hotline
has demonstrated success in engaging veterans
in crisis and connecting them with services.45
Crisis lines are a promising addition to the suite of
services needed to support officer mental health
and wellness.
 2 0 L AW E N F O R C E M E N T M E N TA L H E A LT H A N D W E L L N E S S A C T
Recommendation 8. Support rigorous research that
can evaluate the efficacy of crisis lines and, if supported,
provide data toward considering them an evidence-
based practice.
The current insufficiency of data in this area is not
due to the services provided by crisis lines but
rather to a lack of dedicated research. Research on
crisis lines generally and the usefulness of crisis
lines to law enforcement specifically would allow
services to be tailored to the law enforcement
population based on need rather than supposition.
Research is needed to establish the skills needed by
counselors, the best practices on a call, and the best
means of service referral and privacy maintenance.
Crisis lines can also provide invaluable data on law
enforcement suicide. This type of research can be
carried out within existing programs while incurring
a limited time or financial burden. Experts should
be consulted on how best to collect, protect, and
use the data already collected by crisis lines to
help create an accurate understanding of mental
health crises amongst law enforcement officers. In
the end, evidence-based research, not anecdotal
reports, should govern which programs are
promoted and funded.
Veterans Crisis Line and
Military Crisis Line
The VCL was launched in 2007 and allows either
veterans in crisis or their loved ones to call, text,
or chat online confidentially with a qualified VA
responder. Its call takers are backed up by a referral
network of professional service providers located
in each of the VA medical centers around the
country. As of late 2018, the VA states that since
its creation, the VCL has answered more than 3.5
million calls and dispatched emergency services to
callers in crisis nearly 100,000 times. The program’s
anonymous chat service, introduced in 2009, has
engaged in more than 413,000 chats, and the text-
messaging service has responded to nearly 98,000
texts. All together the call line, chat, and text
services provide veterans with single point of entry
access to confidential, round-the-clock support.
The Military Crisis Line (MCL) is a joint resource
of the DoD and the VA. Promoted to active service
members in crisis and their families, it connects
them to the professionals at the VCL through
its own brand identity. The ultimate referrals for
service may be routed differently for active service
members than for those covered by the VA, but the
system and toll-free number are the same. What is
important to callers in crisis is not only that is the
call confidential but also that the person answering
the phone is someone who can identify with the
military culture and experience and will know how
to refer callers to service providers with similar
knowledge. And one seemingly small but key
aspect of the VCL/MCL program is that it provides
public information on what to expect when making
the call, including the exact language a caller will
hear when the phone is answered (or the chat or
text response for those contact methods). Given
that fear of the unknown can be a significant
barrier to help-seeking behavior, providing military
personnel, veterans, and their loved ones with
clear, easy-to-find and -understand information
about what exactly will happen when they place
the call is an important demystifying step.
Another component of the program is the Veterans
Self-Check Quiz.46 Created in conjunction with
the American Foundation for Suicide Prevention,
it offers a safe, easy way for an individual to learn
whether stress and depression might be affecting
them. The quiz takes less than 10 minutes to
complete, and it is reviewed by a chat responder
who will then leave a personal response offering
options for follow-up in a secure website, usually
 Crisis Hotlines  2 1
within 10–15 minutes. The individual who
completed the quiz then decides what to do next.
They can continue talking with a responder through
the chat without identifying themselves, get a
referral to see someone in person, or decide to do
nothing further at that time.
The MCL itself is actually serviced by the National
Suicide Prevention Lifeline, with military or veteran
callers told to press 1 when they call to reach
someone who will understand their unique needs
and the service networks they have access to. The
U.S. Substance Abuse and Mental Health Services
Administration launched the Suicide Prevention
Lifeline on January 1, 2005. Vibrant Emotional
Health, the administrator of the grant, works with
its partners—the National Association of State
Mental Health Program Directors, National
Council for Behavioral Health, and others—to
manage the project along with Living Works, Inc.,
an internationally respected organization specializing
in suicide intervention skills training. And its work
is independently evaluated by a federally funded
investigation team from Columbia University’s
Research Foundation for Mental Hygiene.47
Crisis lines for law enforcement
In our interviews, we received specific and useful
feedback regarding the specific needs of the law
enforcement community. There are obstacles to
using services that are unique to law enforcement,
both culturally and structurally, and any expansion
or support of crisis lines for law enforcement
personnel should take these into account.
A recurring theme in our interviews was the
pressure that shift work places on normal access to
services. For example, an officer working the night
shift may not be able to get to a doctor’s office in
normal working hours for preventive care check-ups.
If the officer has a co-parent who works during
normal working hours, it can be extremely difficult
for either parent to take a child to the doctor.
Multiple interviewees remarked on the importance
of access to health and mental health services
24 hours a day; crisis lines can operate 24 hours
a day. In addition, they are location-independent.
This means that an officer can access a crisis line
without being physically present and ensure total
anonymity for callers.
Many of our interviewees were from larger
agencies. When asked what resources they
needed to ensure officer mental health and
wellness, we received a surprising and near-
unanimous response: Focus on smaller agencies.
A representative from a national organization
said, “Every large agency is connected to crisis
services.” A chief from a major city department
said, “Honestly, the large agencies can take care
of their own. If Congress is going to take action,
we’d advocate that resources focus on smaller
agencies that can’t afford their own programs.” An
urban district sheriff said, “I’m more worried about
the doughnut districts, frankly. We’re fine, but the
surrounding counties don’t have the resources or
the manpower.”
Firefighters and emergency medical technicians
(EMT) have a dedicated national crisis line48
supported by the National Volunteer Fire Council.
Rigorous data are collected on firefighter and
EMT suicides by the Firefighter Behavioral
Health Alliance.49 The centralized services and
data collection help to provide the most useful
interventions. The disaggregated nature of state
and local law enforcement more closely mirrors
that of the fire service but as practiced puts the
onus on each department to provide services and
many are simply without the resources to do so.
22 L AW E N F O R C E M E N T M E N TA L H E A LT H A N D W E L L N E S S A C T
Interviewees repeatedly made the point that it is
difficult for an officer to open up to someone who
might not “get it.” Working in law enforcement
exposes officers to very specific stressors, and
while a well-intentioned councilor can sympathize,
he or she may not be able to empathize.
Anecdotally, we were told that officers are more
likely to reach out to peers, especially if there
was a good departmental culture around mental
health and wellness. However, the anonymity
of a crisis line may be appealing to an officer
who is personally concerned about speaking
about mental health within the workplace. Crisis
lines staffed by law enforcement or former law
enforcement officers could be an optimal entry
point for officers experiencing a mental health
crisis. There are currently two operational crisis
lines focused exclusively on law enforcement:
Cop2Cop and Copline.
Cop2Cop, which is featured in the case studies
report, was launched in 1998 as a joint effort
between the State of New Jersey Department of
Human Services Division of Mental Health and the
University Behavioral Health Care unit at Rutgers
University.50 It was the first program of its kind.
The hotline is always open, staffed by retired law
enforcement officers, and available to officers and
their families. The program was later expanded to
include all first responders.
Copline was started in 2006 to take the core
concept of Cop2Cop national. Copline is similar
to Cop2Cop: It is operational 24 hours a day,
seven days a week; it is staffed by retired law
enforcement personnel; and it is confidential.
Unlike Cop2Cop, which is publicly funded, Copline
is a registered nonprofit. It has attained an
international presence.
Recommendation 9. Support the expansion
of crisis lines for law enforcement that are staffed
with call-takers and counselors with a law
enforcement background.
Interviews and anecdotal reports suggest that
law enforcement officers may be more willing to
engage with counselors who have also worked in
law enforcement. We suggest that crisis lines for
law enforcement be staffed, to the highest degree
possible, with counselors who come from a law
enforcement background. Specialized training will
be required for counselors with and without law
enforcement experience.
Counselors with law enforcement experience will
require training in mental health crisis response.
While some law enforcement officers receive
a good deal of training in mental health crises,
this training is from a public safety standpoint.
They will need to retrain as counselors, and
appropriate trainings need to be identified.
Research demonstrates that crisis line workers are
more effective when they have more experience.
A large-scale study from Canada and the United
States demonstrated that there was no significant
difference in call outcomes between paid
professional counselors and volunteer counselors.
Instead, counselors who had more than 140
hours of call experience had significantly better
outcomes on calls.51 Furthermore, counselors
who demonstrated empathy and respect had
better call outcomes.
Counselors without law enforcement experiences
may be necessary and useful. Whether serving
as specialists or general responders, civilian
counselors will need to retrain on their specific
population. Possible opportunities include ride-
 Crisis Hotlines  2 3
alongs, time spent embedded in a department,
specialized trainings, or other options entirely.
Experts should be engaged to design and test
effective trainings for civilian counselors.
Recommendation 10. Consider support for a national
crisis line for law enforcement.
If Congress chooses to support crisis lines as
an intervention for law enforcement mental
health crises, support should be provided for a
national crisis line. The deference shown to the
needs of small, rural, and geographically diverse
departments by all of the interviewees indicates
that any measures to expand crisis lines should
include and in fact be designed around the needs
of underresourced departments. Therefore, any
crisis line expansion should be national in scope,
as should data collection efforts. All state and
local law enforcement agencies should have
access to lines. Department leadership should
be briefed on what the lines offer and how they
can support departments.
Critically, the crisis line should offer not only
crisis counseling but also referrals to vetted local
providers. One of the great successes of the VCL
is the national scope that allows its counselors
and specialists to make direct referrals to vetted
local suicide prevention coordinators so clients and
callers ready to engage with services can connect
with appropriate and available care. Removing
obstacles to engaging with care increases the
likelihood of engaging with care. In the same study
that studied volunteers, only 42 percent of callers
who committed to seeking care followed through.52
If crisis line counselors can refer to vetted local
service providers, those referrals may save lives.
Whether that means expanding the VA’s model of
piggybacking on the infrastructure of the National
Suicide Prevention Lifeline, or creating a parallel
service, or expanding statewide programs like
Cop2Cop to all states and territories, enabling
counselors to refer callers to local services is of
critical importance to expanding crisis line access.
Mental Health Checks
The general public has been taught to believe
that regular well-patient visits with a doctor are
important not just for early detection of potentially
serious physical issues but also for simple routine
maintenance of health. Similarly, semiannual
prophylactic dental cleanings are understood to
keep teeth healthier and safer than they would be
if the dentist only saw the patient when something
was observably wrong. Likewise, research
demonstrates the usefulness of check-ups and
check-ins to screen for unhealthy behaviors such
as substance abuse.53 The idea behind recurring
mental health check programs that have been
adopted by some law enforcement agencies is
similar: Practice routine observation to improve early
detection or even prevent serious mental issues.
Research does not conclusively support
comprehensive routine physical exams for
asymptomatic adults. As far back as 1981 the
American College of Physicians noted that
“present data are not adequate evidence justifying
annual complete examination of the asymptomatic
patient at low medical risk.”54 And as recently as
2013 in a metaanalysis of 14 randomized trials
comparing health checks to no health checks,
researchers found that the health checks did not
reduce morbidity or mortality whether overall,
cardiovascular, or cancer-related.55 And for mental
health checks for the otherwise asymptomatic
adult, the evidence is simply not known. It
may seem intuitive to some that preventive
mental health care is likely to be helpful,56 and
there appears to be increasing acceptance of
mental health checks as an effective approach
for mitigating the emotional rigors of a career
in policing. However, in-depth research on the
benefits of such care and the most effective
methods for implementing mental health check
programs remains to be conducted.
At the same time, the stress of police work
is well known. Speak with any veteran police
officer and they will be able to share work-related
experiences that are incomparable to those in
most other professions, that had a significant
psychological impact on them, and for which they
never received counseling or professional support.
Anecdotally, there is broad understanding within
the field that alcohol abuse, divorce, hypertension,
and depression are occupational hazards that
equal or surpass threats of violent encounters
posed by patrolling and fighting crime. The data
also support this reality. In 2017, 46 officers were
fatally shot in the line of duty while more than
three times as many died by suicide.57 So law
enforcement officers may not universally qualify
as asymptomatic patients at low risk; they may
therefore benefit from proactive screening.
Despite intense demands on their psyches, law
enforcement officers’ mental health needs are
often overlooked until a response is necessitated
by negative behavior or a significant event. Even
when resources are available, many officers will
not seek help voluntarily—either because they do
not recognize their need for emotional support or
because of the strong stigma in American policing
associated with seeking emotional support.
“In police culture, a major obstacle that
impedes the maintenance of psychological
health is the stigma attached to asking for help.
Law enforcement culture values strength, self-
reliance, controlled emotions, and competency
in handling personal problems. These values
discourage help-seeking behavior, and there
is a sense of having lost control by asking
someone else to help fix the problem. If these
values are held too rigidly, an officer can feel
weak, embarrassed, and like a failure for
seeking help from others. One study found
 2 6 L AW E N F O R C E M E N T M E N TA L H E A LT H A N D W E L L N E S S A C T
that stigma and help-seeking attitudes were
inversely related. In other words, a person
facing a higher level of stigma for seeking
help was less likely to have a help-seeking
attitude. This generates concern for officers
who unconditionally conform to the traditional
values of law enforcement culture—they will
be more likely to avoid seeking help, even
when distressed, and potentially pay the price
of detrimental health effects.”58
This situation is slowly improving, but there is
still a long way to go. One expert interviewed
said, “There are obstacles to officers seeking the
help they need. Number one is stigma—the fear
in seeking help. The field has done a lot better
recently at getting away from its culture that
stigmatized needing any kind of help. But we now
need to help officers understand that needing help
is not a weakness and that getting help does not
put their future assignments in jeopardy.”
Officers can be fearful of being considered weak
or untrustworthy; concerned that seeking help
will lead to sanctions or loss of professional
opportunities; or wary of other perceptions. In
these instances, officers are often unlikely to seek
help even privately—doubting their treatment will
remain confidential or be understood.
Their fears may not be without merit; some
departments have policies requiring mental health
treatment be reported, especially if it involves
medication. Even when that is not the case, the
small and communal nature of many departments,
along with regressive attitudes about emotional
health, can render stigmatization a real threat.
When stigma does not prevent an officer from
seeking support, self-recognition and access
to services can also present challenges. While
effective in some situations, a reliance on voluntary
referral causes some officers to fall through the
cracks. The result: Law enforcement supervisors,
mental health providers, fellow officers, and family
members are often unable to identify the need for
emotional support or services before a debilitating
effect on the officer is evident.
There is no large-scale or sufficiently rigorous
research on the efficacy (or lack thereof) of mental
health checks—at any regular interval—for law
enforcement professionals. It has been suggested
that even without evidence of their efficacy,
proactive mental health checks have become a
growing practice among first responders. In the
2017 employee assistance program (EAP) manual
for employees of Barnes–Jewish Children’s
Hospital in Boston, Cynthia Hovis writes, “First
responders, police, fire departments, military
personnel, and medical staff started the practice [of
annual mental health check-ups] in recent years.”59
The National Surveillance of Police Suicides study
conducted by the Badge of Life Police Mental
Health Foundation “tentatively attributes [an
11-percent drop in police suicides in a four-year
period] to . . . ‘the increased willingness of officers,
many of them younger, to seek professional
assistance’–not only when they have a problem
but also through preventive measures such as
annual mental health checkups.”60 But these
discussions do not point to particular programs or
to organizations that use them. There is no formal
indication of how many U.S. law enforcement
agencies have implemented mental health checks
or even a clear picture of just what such checks
entail, but among law enforcement executives
and clinicians who specialize in supporting law
enforcement officers, they are a slowly increasing
approach to prophylactically mitigating the inherent
stress of the profession rather than waiting for
problematic symptoms to appear.
LEMHWA specifically referred to annual checks,
but some interviewees noted that even less-than-
annual periodic checks that take into account key
career transition points may be just as effective;
the support for this concept in the field is based on
 Mental Health Checks  2 7
a desire to assess mental and emotional wellness
regularly, not just at a hiring screen and then in
reactive checks following critical incidents.
Mental health checks are typically conceived as a
mandatory process of having officers meet with
a clinician, members of an internal peer support
team, or supervisors to discuss aspects of the
officer’s work that need emotional navigation.
The approach used varies by department, with
some focusing on operational debriefings while
others look to preventive screenings. For example,
in Mundelein, Illinois, a new wellness program
implemented in late 2018 requires police officers
to meet with a psychologist annually in addition
to their physical fitness exam.61 But mental
health checks are distinct from pre-employment
screening, fitness-for-duty evaluations, or
structured psychological counseling. “’It’s not
meant to be a fit for duty examination or a head
check,’ [Police Chief Eric] Guenther said. ‘It’s really
meant to be an outlet and a conversation and a
source for coping mechanisms.’”62
There is also an increasing belief in the potential
need to expand mental health checks to civilian
staff, given the recognition that the stress
of working on police-related matters and the
aftermath of critical incidents also impacts
dispatchers, crime scene technicians, and victim
advocates, and other nonsworn staff.
Advocates of implementing mental health checks
believe they can be beneficial in several ways.
When they are a requirement for all officers, they
can significantly reduce stigma associated with
engaging in discussions about stressful aspects of
the job. Chief Guenther of the Mundelein Police
Department noted that voluntary check-ins with
a police psychologist were ineffective because
nonrequired check-ins seldom took place at all.
“There’s too much pride in this profession. You
have to be the big tough cop, right? And you
can’t be seen as being weak.”63 In departments
that make mental health checks mandatory for all
officers or for specific units, engaging in discussion
about stressors is less likely to be perceived as
the exclusive domain of officers unable to cope
with the demands of the profession or who are
considered to be at risk. Moreover, the challenge
of having officers independently recognize when
they may need to seek support is reduced. Mental
health checks may essentially infuse nonclinical
services into the department and help identify
those in need of structured treatment.
When conducted in group settings, mental
health checks are often viewed and positioned as
group “rap sessions” rather than a one-on-one
opportunity for officers to share any individual
concerns in a safe, nontreatment setting. Group
sessions are believed by some to have positive
benefits. They can enable positive peer influences
and create understanding by officers that the
challenges they face are not unique and do not
stem from individual shortcomings. Group mental
health checks can also encourage ongoing positive
peer exchange and normalize the understanding
that stress requiring attention is an inherent part of
the profession.
Approaches
Some law enforcement agencies have mental
health checks exclusively following stressful
incidents when there is a perceived need to
assess or respond to the emotional state of
officers, and others implement regularly scheduled
mental health checks as an ongoing approach for
supporting officers or identifying those who may
benefit from structured treatment. Mental health
checks are sometimes implemented for patrol
units, specialized units (e.g., SWAT, Violent Crimes
Task Force, child welfare, sex crimes, etc.), or for all
sworn officers within a department. The approach
used varies by department.
 2 8 L AW E N F O R C E M E N T M E N TA L H E A LT H A N D W E L L N E S S A C T
Immediate post-incident mental
health checks
One of the more reactive approaches for
conducting a mental health check program often
borne out of incident-driven necessity, or one
aspect of a more comprehensive mental health
program, is a post-incident mental health check.
This form of a mental health check process or
program is often viewed as a type of psychological
first aid. The goal of this approach is to ensure
that an officer’s emotional state is observed and
considered immediately following a critical incident
and that an officer’s need for support does not
compromise the department’s level of service.
Departments typically assign a mental health
incident commander to oversee officer mental
health. This individual may serve in this role for
only a few days while a more extensive mental
health response is organized. Alternatively, they
may be the only person dedicated to supporting
officers following an incident. The person is
usually a trusted police psychologist, a licensed
mental health professional, a licensed employee
assistance provider, a member of the department’s
command staff, a departmental chaplain, or the
appropriate officer from a neighboring department.
The mental health incident commander’s
responsibilities typically include the following:
• Monitoring officers’ behavior and verbalizations
on scene to determine if anyone needs
immediate assistance
• Ensuring that a mental health provider or
supervisor checks in with all officers involved
before the end of shift
• Being available to consult with the chief and
command staff as appropriate and permissible
by policy
• Sharing information about available
mental health resources with officers
and connecting with officers’ family members
if needed
Recurring mental health checks
Recurring mental health checks are typically
scheduled at regular intervals to provide officers
and civilian staff with an opportunity to speak to a
trusted and qualified professional with whom they
can share any concerns. It is most common that
the individual conducting the mental health check
be a licensed psychologist who can identify officers
in need of counseling and has the ability to provide
informal psychological support for minor challenges
that an officer may be experiencing.
There is evidence of regular mental health checks
being mandated as often as each quarter and
as seldom as annually. Some departments also
structure their program by scheduling regular hours
each month that a mental health service provider
is available on premises and allowing officers to
voluntarily check in. Other departments’ mental
health checks are conducted in group settings
rather than one on one. Mental health checks
typically last between 30 and 90 minutes and
provide officers an opportunity to address any
issues the officer chooses while not requiring
disclosure of concerns. Regardless of the
approach, there are some common expectations of
recurring mental health check programs:
• Providing officers with readily available access
to a professional who is able to support minor
challenges they are confronting
 Mental Health Checks  2 9
• Identifying officers who may be in need of
structured counseling or support and working
with those officers to provide them with
appropriate resources
• Reducing the stigma associated with counseling
and accessing services and encouraging officers
to focus on their emotional wellness
• Familiarizing officers with a mental health
professional so if the need for structured
services arises an officer is more likely to
engage with that familiar professional
• Helping the practitioner develop a working
understanding of the department culture and
officers so they are best prepared to provide
culturally competent support when the need
inevitably arises in the future
• Fostering a culture of emotional wellness
within the department and advancing the
understanding that high levels of stress are an
inextricable part of the profession and are best
navigated proactively
U.S. Department of Defense remote mental
health check
In an effort to ensure the mental health readiness
of military service members preparing to deploy,
the DoD, as prescribed by the National Defense
Authorization Act of 2010 (Public Law 111-84,
28 Oct 2009, Title VII Health Care Provisions,
Section 708), mandates the provision of a
“person-to-person” mental health assessment for
each member of the Armed Forces deployed in
connection with a contingency operation (hostilities
against the United States).
For reserve units and their members who do not
have readily available access to military healthcare
providers before they are called to active duty
for deployment, the DoD has implemented
the Reserve Health Readiness Mental Health
Assessment Program. This mental health check
program can be conducted remotely but still
ensures a face-to-face mental health assessment.
The process includes three stages and is
concluded only upon the deploying reservist
interacting directly with a trained
service provider. This interaction can occur
face to face, telephonically, or via a DoD
Telehealth videolink.
The first stage is a self-report survey that
screens for post-traumatic stress disorder
(PTSD), depression, stress, alcohol abuse,
suicidality, and problematic family relationships
and is submitted to remote assessors. If the first
stage does not show any areas of concern upon
assessment, reservists bypass the second
stage and proceed to the third stage, which
is the in-person assessment.
The second stage is required only if a reservist’s
initial self-assessment shows potential areas of
concern. This stage is a follow-up self-report survey
that further queries the reservist about PTSD and
depression symptoms and establishes a more
informed evaluation by the trained provider during
the third stage.
During the third stage, as part of the in-person
assessment, the provider reviews and clarifies
the reservist’s responses, identifies areas of
concern, and refers the reservist for specialty
care as appropriate.
While there are aspects of this approach to a
mental health check that could be replicated for
departments that have limited resources or face
other factors that prevent the implementation of
an in-house program, there is no guarantee that
this approach will fit law enforcement. Preparing
reservists for extended deployments away from
their jobs, homes, and the protective factors of
 3 0 L AW E N F O R C E M E N T M E N TA L H E A LT H A N D W E L L N E S S A C T
their families and communities is a different goal
than ensuring the continued wellness of law
enforcement officers in the course of their career.
Suggestions for furthering mental
health checks in law enforcement
Recommendation 11. Support research to
determine the efficacy of mental health checks,
establish which approaches are most effective, and
provide resources that move law enforcement toward
best practices.
The acceptance and support for recurring mental
health checks as an integral part of a comprehensive
mental health program is based largely on the
vision of law enforcement executives and expertise
of the clinical professionals with whom they
collaborate. The result of these efforts has been
the emergence of a call for a proactive method for
bringing meaningful support resources to officers
in a manner that reduces stigma and helps embed
a focus on emotional wellness. However, it is
important to ensure the process is defined and
understood by everyone involved. One former chief
we spoke to noted that in his last department, “our
psychologist did periodic evaluations”—i.e., mental
or emotional assessments at regular intervals—“for
officers in vice, narcotics, [and] SWAT and for people
in long-term specialty assignments, but I wouldn’t
characterize those as . . . mental health checks.”
(Emphasis added.) Providing clarity about what
works and how federal, state, and local agencies
can implement effective programs is a substantial
need. It is equally if not more important to identify
the most effective methods for conducting a mental
health check program and ensure that
any intervention is not unintentionally harmful
to officers. Formal research and guidance for
the field would ensure that limited resources
are spent responsibly and effectively. Even a modest
investment in pilot sites could provide critically
needed data before large-scale implementation
funding is committed to programs of questionable
efficacy. This is also true for the initial hiring
screening process, where, as one interviewee
noted, universal and clear clinical guidelines based
in research are needed to determine a person’s
ability to safely perform the essential functions of
law enforcement work. People applying for law
enforcement jobs are not blank slates—they bring
with them their past experiences and, in some
cases, diagnosable conditions—but those need
not always be disqualifying.
Recommendation 12. Consider methods for
establishing remote access or regional mental health
check programs at the state or federal level.
Once research has identified promising models
for mental health checks, there will inevitably
be many law enforcement agencies that will not
have the capacity or local access to the necessary
professionals to implement an effective program
(whether preventively or post-incident). In these
instances, having access to a program that allows
for remote assessment and engagement with
mental health professionals has potential. When
the appropriate mental health professionals are
not available for an underresourced, rural, or very
small department—or simply to gain scales of
economy—remote access and regionally oriented
programs that serve multiple jurisdictions may
be of benefit.
However, for such a program to develop resources,
incubation and a collective focus is required.
Entities that work at the federal, state, or possibly
regional level are best positioned to advance this
concept and convene the level of support needed
to be effective.
Peer Mentoring Programs
The benefit of the peer in the facilitation of
counseling has been well documented for many
years in a variety of settings. As long ago as the
late 1960s, the mental health profession saw an
advantage in peer counseling when C. Eisdorfer
and S.E. Golann advanced guidelines for the use
of peer counselors in the mental health field.64
Research has shown that paraprofessionals, which
is what a trained peer mentor is relative to a
behavioral health practitioner, “frequently achieve
clinical outcomes equal to or better than those
obtained by professionals.”65 Peer counseling has
also been shown to have an effect in the treatment
of addictive behavior such as alcoholism.
Peer support and mentoring programs in law
enforcement agencies are also not new. Some
agencies began making use of peer support in
the early 1970s, earning recognition as models
for crisis incident management. For example, L.N.
Blum has described how in in 1974, the Portland
(Oregon) Bureau of Police began a program called
the Traumatic Incident Corps. It was established
when the department observed that some officers
who had been involved in traumatic incidents were
still suffering the results of the trauma experienced
during those incidents. They saw behaviors such
as alcohol and drug abuse, violations of law and
departmental policy, and insubordination. Looking
to improve how the department dealt with these
officers, the bureau turned to other officers who
had themselves been involved in trauma.66 The
Boston Police Department also started a critical
incident stress peer support program in 1974.
Initially similar to what was taking place in Portland,
as the program became more effective its scope
was expanded to include addressing stress that
resulted from employees’ financial situations,
marital problems, department layoffs, and
administrative policy changes.67
Current practice
Today, peer-led critical incident stress debriefing
(CISD) is widely used in law enforcement agencies
in the aftermath of traumatic incidents. Caring for
other human beings in a crisis can be incredibly
challenging and lead to secondary traumatic stress,
so agencies’ efforts to help officers process their
own emotional reactions are important. However,
the evidence to support critical incident debriefing
programs as part of preventing secondary
traumatic stress is subject to the implementation
model used. A 2002 metaanalysis published in
the Lancet found that Critical Incident Stress
Management (CISM)—the most common program
model implemented in a variety of first responder
fields—was no more effective than no intervention
at all in preventing the development of PTSD.68 This
does not mean all CISD practices are ineffective
but that it is important for agencies to understand
there are different models and protocols for CISD
and the choice of protocol matters.
There are also many peer programs that provide
support for broader purposes, helping officers
struggling with any aspect of their lives that may
affect or be affected by the job or even being used
to promote healthy lifestyles to all officers. This
variety of uses can be seen in a number of the
case studies that accompany this report. This use
of peer programs to improve overall wellness is
also backed by evaluation research: Peer-led health
and safety trainings have been shown to have a
positive effect on the targeted lifestyle behaviors.69
Where peer support programs exist in law
enforcement agencies, they succeed because the
peer volunteers understand the job of those they
seek to support. They do the same job, or they
did earlier in their careers. They have also been
there, in the same place as the officer in need
 3 2 L AW E N F O R C E M E N T M E N TA L H E A LT H A N D W E L L N E S S A C T

of support. This makes them usually much more
accessible than a behavioral health professional.
“This availability, coupled with a greater ease of
interaction, may give the peer the edge needed
to do extremely effective intervention in times of
crisis. Peers are equals. They would be confidants
even if they were not crisis interveners.”70 This is
also why peer support programs may exist even
when agencies have other EAPs. An EAP may offer
many of the same services, but it might not be
located where the officer is, or available 24 hours
a day, or be staffed with people with direct law
enforcement experience.
This is not to dismiss the EAP as a valuable tool in
a holistic and multimodal approach to wellness and
resiliency. As one individual noted in an interview
for this report, while there may be poor EAPs out
there, in general they likely have an undeservedly
negative reputation and one that is most likely
perpetuated by people who have never made any
use of an EAP. But he added, “I like to tell people
that [in my experience] you cannot raise three
teenaged daughters and not use [the] EAP.”
Peer support programs are sometimes under the
auspices of chaplaincy programs, which some
interviews noted can help reassure officers that
their engagement with the program will be kept
confidential. And chaplaincy programs are an
important piece of wellness support in agencies
even when they are not connected to peer
support programs. But even when programs are
housed elsewhere, clear confidentiality rules are
important to their success. The team that worked
on the mental wellness case studies found that
an occasional downside of efforts to ensure
confidentiality is that these important programs
don’t always keep the types of statistics that
can help demonstrate performance success that
can be necessary to securing ongoing funding.
Another challenge one individual noted was that
“there can be perceptions [among command staff]
of peer mentoring programs not holding people
accountable.” He went on to note that there are
questions about how much do you invest in a
person who may ultimately be disciplined as a
result of their actions, but that “I think you can
take a general approach of separating the person
from the employee and balance confidentiality and
assistance with accountability by considering the
egregiousness of behavior.” And the more clear
policies are up front, particularly in terms of what
lines cannot be crossed no matter what, the better.
Recommendation 13. Support the expansion of peer
support programs to ensure all officers have access to
this important wellness service.
Whether as the entry point to professional
psychological services or as the end point
for career and life advice, it is clear that law
enforcement officers value peer support
programs and that they are critically important to
officers’ well-being. Research on organizational
connectedness has shown that the quality of
peer relationships and organizational support of
them are correlated with self-reported stress
among officers, making both formal and informal
peer networks critical to both organizational
and individual resiliency.71 One interviewee also
suggested that ongoing career mentoring can
serve as a type of mental health check-in.
And these efforts need to be led by officers
whom people in the organizations trust and
admire (working in consultation with professional
behavioral health specialists). Command-level
endorsement of the idea of taking care of yourself
both physically and mentally is important, but it
does not exceed the importance of the program
being perceived as independent of management.
Multiple interviewees noted that quiet but
consistent support from senior leadership was
critical to program success but that care must be
taken so that command staff are not seen to be
the ones pushing or forcing employees to use the
 Peer Mentoring Programs  3 3
services. The drive to use services comes from
peers or immediate supervisors. Modeling the use
of services can be important for senior leaders to
do, however, as part of the process of normalizing
help-seeking behavior. The inclusion of retirees
in the peer support network can also improve
perceptions of independence.
Recommendation 14. Support the expansion of peer
programs to include broader health and wellness, not
just critical incident stress.
Even for agencies that have peer support programs
for those involved in critical incidents, serving
in certain types of assignments, or involved in
shootings, there is room to grow the programs to
cover a wider range of issues—both personal and
professional—that can impact officers throughout
their careers. Peer programs that are involved in
stress management training and mentoring young
officers as well as assisting with advice on things
like sleep, nutrition, finances, marriage and child
rearing, balancing a career with caring for elderly
parents, and all the other things can affect the
officer on the job can raise their presence and
profile with officers. Not only does this help show
officers that they matter—that they are valued as
people as well as employees—but it can also help
break down the stigma of seeking assistance when
in crisis. Reaching out to peer mentors you already
know is always going to be easier than reaching
out to strangers.
Obstacles to adoption
But despite the longstanding practice and available
evidence on the efficacy of peer support programs,
they are not ubiquitous, and some departments
face ongoing challenges to supporting well-
trained peer programs. For very small agencies,
the perception of confidentiality can be difficult
to achieve even if there are strong peers in the
department and the means to train and support
them. For larger agencies, maintaining the network
of peer mentors can be a challenge. It can be
demanding work in its own right—so the peer
mentors themselves need ongoing training and
support. As departments appear to be moving in
the direction of more holistic wellness programs,
this movement may address the increasing
demands of peer mentors risking exceeding the
time and expertise of any one individual, particularly
for those who are volunteering to serve their fellow
officers in addition to their regular job duties.
Recommendation 15. Support alternative models to
agency specific peer programs, such as through regional
collaborations or labor organizations.
Part of the support for expansion of peer support
programs should also explore alternative models
for administering programs. For example,
regional programs could be used to assist
smaller agencies who may be unable to support
an in-house program. In a regional or statewide
effort, volunteers from multiple departments
or even networks of retirees can provide peer
support services to a broader area. This type of
regionalized effort still allows for the program
to be a bridge to locally available professional
services when appropriate. It also can encourage
trust in confidentiality by allowing officers to
seek assistance and advice from a peer who
can understand the experience without being a
coworker in the same small department.
Rank-and-file organizations and labor unions may
be a vehicle for delivering this type of non–agency
based model of service delivery. More than
one interview noted that in places where labor
unions have contracted their own EAP providers
the arrangement has generally been a positive
development—helping to offset some of the
general suspiciousness around confidentiality
that officers have. In fact, regardless of where a
program is housed, labor organization support and
 3 4 L AW E N F O R C E M E N T M E N TA L H E A LT H A N D W E L L N E S S A C T
engagement is critical. When new programs are
created, perceptions of the owner or champion
of the work can make or break program success.
When labor organizations endorse programming
and local providers, officers see those services as
being for them.
Recommendation 16. Support training programs for
peer mentors for peer support programs to expand.
Agencies need to make serious investments in
selection, training, and oversight of formal peer
mentors.
Peer mentors need to be nonthreatening and
confident in being able to recognize the signs of
problems because people aren’t generally good
at identifying their own. Training is particularly
important to building programs that are not single
modality efforts. Not all approaches and treatments
work the same for everyone, so comprehensive
programs that can help officers find the right
treatment fit for their needs is also important.
Building programs that are trusted to assist officers
in need but not viewed as overriding agency needs
to hold people accountable to their own behaviors
is also a balance made easier by having well-trained
peer mentors with behavioral health professionals
supporting their work.
Peer mentor training is not a single event but an
ongoing investment in the program and its peer
mentor staff, whether they are departmental
employees or local retirees. Ensuring that peer
programs have access to training that they can be
sure is relevant and useful in a law enforcement
context is critical.
Any support for the expansion of peer support
services within agencies also must not overlook
the need to support the peers themselves. It can
be emotionally draining and demanding work to
help those in crisis—and peer supporters are
not themselves behavioral health professionals.
Programs need to consider the long-term exposure
risks of retraumatizing experiences and ensure
consulting relationships exist with psychologists,
psychiatrists, or other mental health experts. This
is particularly important for programs that identify
peer mentors based on their previous experience
with critical incidents, such as when support
officers in shooting cases must have experienced a
shooting themselves. While this experience can be
invaluable, it can also lead to additional trauma for
the mentor.
Recommendation 17. Remember all the types of
agencies, including federal, when supporting peer
programs for law enforcement.
Often when we think of law enforcement, we
focus on the state or municipal officers we see on
patrol on our highways and in our neighborhoods.
But thousands of law enforcement professionals
are sheriffs’ deputies who work in courts and
corrections. Many other officers are assigned to
special units like homicide, sex crimes, narcotics,
and others, sometimes working undercover. While
many of the same stressors and health impacts
exist for these officers, there are also others,
particularly for those working in jails. Federal
law enforcement officers face similar stressors
and risks, but in a different work environment.
Efforts to expand peer support programs for
law enforcement need to cross all types of
law enforcement. Support to expand programs
in federal agencies may look different than
similar efforts in state, local, or tribal agencies.
Regardless of setting, the basic principles are
the same: Provide support where officers are,
be responsive to the experiences of officers, and
support the whole health and wellness of officers.
Additional Recommendations to Support the Mental
Health and Wellness of Federal, State, Local, and Tribal
Law Enforcement Officers
This report primarily sought to respond to the
specific matters raised in LEMHWA, namely around
peer support, crisis lines, annual mental health
checks, and potential models from the DoD and the
VA that could have applicability in law enforcement.
However, in the course of conducting the research
and consultation necessary to that task, we identified
some additional broader themes concerning support
for the mental health needs of law enforcement.
In this section we look at the importance of privacy
protection and resilience training, the needs of
civilian support staff, and the benefits of whole-health
approaches to officer wellness.
Privacy considerations are key to the
success of peer-led programs
Protection of their privacy, both internally in a
department and externally, is a major concern for
officers seeking mental health care.
Internally, officers may face ridicule or professional
scrutiny for engaging with what one interviewee
referred to as “the sad clown club,” also known
as the departmental mental health offerings.
One interviewee said, “Every department will
say that they have an EAP, but unless you have
a departmental culture of mental health and
wellness, it is an open secret that getting help
can jeopardize your job.” Officers are aware that
there is a departmental liability to fielding officers
with ongoing mental health concerns. A federal
interviewee said, “There are always agents who
are simply going to pencil-whip the fitness-for-
duty assessment. You can’t really prevent that.”
Although all officers understand the importance of
medical and psychological fitness for duty, undue
pressure within a department may keep officers
from seeking help, preferring to appear as fit as
possible and return to active duty in the shortest
possible time. Other officers may have financial
commitments that make the risk of unpaid time
away from work untenable. Education, clear policy,
and consistent processes may help officers take
personal responsibility for their fitness, rather than
hiding concerns that can be treated successfully
and confidentially without endangering their
employment.
Externally, officers are public servants. Unless
the strictest privacy standards are maintained, an
officer’s mental health care may be discoverable
on the public record, be used in court proceedings,
or affect employment eligibility. One federal
interviewee said that his component had been
making aggressive efforts to limit the impact that
mental health treatment has on procedures such
as background checks for security clearance so
that agents would not avoid treatment for fear of
curbing career advancement.
HIPAA, the Health Insurance Portability and
Accountability Act of 1996, is what most people
think of as protecting their personal health
information from public disclosure. But not
everyone is a HIPAA-covered provider—it applies to
doctors, psychologists, clinics, and pharmacies as
well insurance companies and government-funded
programs like Medicare, Medicaid, and veterans’
health programs. It does not apply to peer-run crisis
lines or in-agency peer support programs. Clergy-
penitent privilege prevents clergy from being
required to disclose confidential communications
in a court proceeding, and that is why some peer
 3 6 L AW E N F O R C E M E N T M E N TA L H E A LT H A N D W E L L N E S S A C T
support programs are run out of chaplaincy offices
in law enforcement agencies. But not all programs
can realistically be managed and maintained by
ordained clergy, and there is no guarantee that
privilege would extend to lay staff working under a
chaplain’s purview.
Even if most people are not aware that speaking
with an employer-run crisis line or peer program has
no privacy guarantee, all of our interviews made
it clear that officers are. And if law enforcement
officers are going to be encouraged to call peer crisis
lines or make use of other peer-support services,
they will need to know that what they say will be
kept confidential. They need to have confidence that
what they say will not be subject to public disclosure
either to their chain of command—possibly
jeopardizing their careeror subject to discovery in
judicial proceedings, possibly jeopardizing both
themselves and their agency.
Knowing that the public can potentially access
sensitive personal information may ultimately
deter officers from seeking treatment. This may
be of particular concern for smaller jurisdictions—
most especially tribal communities—where there
are limited service providers and other natural
limits on privacy.
Recommendation 18. Improve legislative privacy
protections for officers seeking assistance from peer crisis
lines and other peer-support programs.
Very few states offer this kind of privacy protection
for crisis lines and other programs run by agencies
or active duty law enforcement volunteers. In 2009
Washington State enacted legislation saying that
“All communications to crisis referral services by
employees and volunteers of law enforcement,
correctional, firefighting, and emergency
§ This was in the enrolled language of H.B. 5231, 100th Gen. Assemb., Reg. Sess. (Ill. 2018) but was removed by amendment in final passage of Public
Act 100-0911. It is expected that it will be addressed in the next session of the Illinois General Assembly.
services agencies, and all records related to
the communications, shall be confidential.”72
Unsurprisingly, there are multiple public safety crisis
lines with referral services based in Washington
State. Indiana enacted legislation effective in 2017
that exempts critical incident stress management
service communications from being subpoenaed.73
Illinois introduced similar, but more expansive,
legislation that would create the Law Enforcement
Support Program Confidentiality Act. If passed, this
law would have
“[Provided] that information, omissions,
confessions, or other communication obtained
by a participant in a peer support program
involving a peer support counselor from a law
enforcement officer, public safety employee,
peace officer, firefighter, or emergency services
personnel shall be considered confidential
information and shall not be released to any
person or entity, including, but not limited to, a
court, administrative agency or tribunal, or public
officer or employer, unless: (1) to the extent it
appears necessary to prevent the commission of
an act that is likely to result in a clear imminent
risk of serious physical injury or death of a
person or persons; (2) when required by court
order; or (3) when, after full disclosure has been
provided, the person who made the confession,
admission, or other communication has given
specific written consent.Ӥ
Guidance or model legislation is needed to
ensure officers can make use of peer-run support
services without fear of disclosure of private health
information. Furthermore, efforts to expand the
usefulness of peer-led support programs should
be paired with efforts to collect meaningful data.
Guidance is needed on how best to securely
collect and protect vital data so aggregated and
anonymized data can be collected and analyzed to
evaluate program effectiveness.
 Additional Recommendations  37
Building resilient officers begins, but
does not end, in the academy
Resilience is the ability to cope with and recover
from stress, adversity, and trauma. One interview
subject observed that while he had long thought
about the need to hire resilient people to work in
this demanding career, he has come to learn that
resiliency may not be innate and that it definitely
can be taught. Recognizing this, some of the
departmental wellness programs featured in
the wellness case studies (such as Indianapolis
and Milwaukee) are housed in or attached to the
agency’s training facility. Another chief recounted
that in his former departments he gave every
recruit a copy of Dr. Kevin Gilmartin’s book,
Emotional Survival for Law Enforcement, and
tried to always bring Dr. Gilmartin to speak to his
academy classes about what recruits could expect
on the job and how to mitigate the stress and
trauma risks. His hope that was that these future
officers would avoid the worst effects of trauma
exposure, be less afraid to seek assistance, and
understand the cycle of recovery from trauma
exposure. “With this hopefully they never reach
the point of self-medication or self-harm.” And yet
another interview pointed out that the work of
people like Dr. Gilmartin and others are critical to
reminding cops that they are “not just cops;” they
are also people with relationships and interests and
responsibilities away from the job, and those things
are important to their ability to be resilient.
It must not be ignored, however, that it is difficult
to promote and build resilience in stressed
organizations. Since 2008, most departments have
experienced resource shortfalls across personnel,
equipment, and training, and many interviewees
pointed out the ongoing pressure to do more with
less impacts officer morale. This is combined with
challenges of recruitment and retention that have
been exacerbated by a national discourse that
makes many officers feel that both their profession
and their professionalism are undervalued. In
this environment, the organizational climate adds
stress to what is already recognized as one of the
most stressful occupations. Research is beginning
to show that law enforcement officers operating
under stress may well be at greater risk of making
errors that can compromise their performance and
public safety.74 In addition, the chronic stressors of
police work can have a significant adverse impact
on both physical and psychological health.75
But there is hope that developing stress resilience
and self-regulation skills in officers can mitigate the
negative effects of stress on decision-making.76 In
addition to learning to quickly regain their balance,
both psychologically and physiologically, after
intense moments on the job, officers can also be
given tools to help them manage thoughts and
emotions that come up long after incidents have
passed. Data suggest that “training in resilience
building and self-regulation skills could significantly
benefit police organizations by improving judgment
and decision-making”77 and decreasing the
frequency of on-the-job errors that can result in
injuries, death, and even legal liabilities.
Recommendation 19. Support the identification,
development, and delivery of successful resiliency
training programs for both academy and periodic in-
service settings.
There is a growing body of evidence in support
of increased resilience training in the academy
both in terms of understanding the risks and in
teaching skills that can help mitigate exposure to
stress. There are agencies—including some of
those featured in the case studies report—that
have begun to bring resiliency training in their
academies and in-service training programs, but it
is not universal. And in an academy setting these
discussions are fairly academic, as the recruits have
no on-the-job experience. So retraining on both
awareness and skills throughout a career is also
 3 8 L AW E N F O R C E M E N T M E N TA L H E A LT H A N D W E L L N E S S A C T
key. It is generally accepted that health prevention
interventions work best when there are follow-up
refreshers to reinforce knowledge and skills.78
This training should include information on the
physical effects of stress, skills to moderate the
physiological responses to stress, the normalization
of help-seeking behavior, and information on the
benefits of peer support. Evaluation work of one
such training model as implemented in Australia
also suggests that training programs should
focus on positive attributes—what they termed a
“strength focused approach and narrative”—and
the building of social cohesion among officers.
This is supported by research that suggests that
a sense of workplace connectedness is a vital
protective factor against depression.79 And this
is also consistent with research that has taken
place in law enforcement agencies that shows
that organizational factors have a greater impact
on individual’s levels of stress than operational
factors.80 Particularly for federal, state, and larger
municipal agencies that run their own academies,
this promotion of workplace connectedness can
begin in the academy setting where recruits are
future co-workers.
While there are existing training programs that
focus on the positive strengths of police officers
and remind them of what motivated them to serve,
and those training programs can be a starting
point, they are most often applied as one-time
trainings in either the academy or at a single
point in a career. Additional support to build out
training programs that support officers through
the many phases of their career and refresh their
skills in modulating their stress response is also
important. In addition, the use of on-line training
modalities for supplemental or refresher training
may be an efficient way of providing large-scale
reinforcement training for the more than 800,000
law enforcement officers working in this country at
any given time.
Recommendation 20. Support training programs
that promote the universal application of preventive
interventions, including skills to manage stress.
In the preventive services world, interventions
are generally classified as universal, selective,
or indicated. The first applies to everyone in the
population, the second to a group identified as
being at greater risk, and the third to individuals
who are symptomatic. Peer support and crisis lines
primarily address the needs of the symptomatic.
Critical incident stress management or other
psychological health checks for trauma exposure
for those in special assignments or present
at major critical events address the selective
population at specific greater risk. But whole
career training speaks to the universal, and the
use of this universal application has two potential
benefits. First, there is a demonstrated population
health benefit from the preventative application of
information; individuals do not need to be suffering
before exposure to treatment. Exposure may help
those individuals better self-identify when they
are in need of help in the future. They are more
aware of the signs and have a better sense of
what seeking help will involve. Second, universal
exposure provides intervention for everyone, and
no one is stigmatized.
A critical area for this universally applied training
is in the area of teaching officers to manage
their stress response more adaptively. Broader
access to resilience training throughout a career
is important because when individuals are under
stress, the body’s sympathetic nervous system
response can be triggered, raising their heartrate,
reducing the ability to think critically, and potentially
leading to declines in operational performance. In
light of a growing field of study examining how
people working in high stress jobs can be taught
to manage their response to trauma and stress
through things like breath work, mindfulness,
and meditation, support to greatly expand law
enforcement’s access to this is potentially a key
 Additional Recommendations  3 9
tool in a comprehensive approach to mental health
and wellness. Those who make use of these self-
regulation skills in their daily work can improve
their job performance, their health, and their
engagement with their personal lives.
Civilian staff must not be forgotten
To the extent that there is increased focus on
mental health and wellness in law enforcement,
it has largely been focused on the needs of
sworn officers. However, as we were researching
the provision of mental health services with
law enforcement executives, membership
organizations, clinicians, and others, there was a
consistent prompting to ensure that the needs of
civilian staff were not overlooked.
Quantifying and qualifying the provision of mental
health services for sworn officers uncovered a
scarcity of empirical findings. Looking into services
provided for civilian staff of law enforcement
agencies produced even less definitive information.
The reason for this may be twofold:
1. Mental health and wellness services provided
to civilian staff are hard to enumerate because
their services are generally intermixed with the
vast population of active municipal employees
respectively. As such, they are empirically
indistinguishable from all municipal employees.
2. Services for civilian staff can be unintentionally
overlooked by policy makers given the lower
profile nature of their responsibilities and
status within law enforcement agencies,
their relatively scant numbers compared to
sworn officers, the perception that they are
sufficiently distant from duties that cause
mental health–related stress, and the fact that
they generally are not supported by strong,
profession-specific advocacy organizations.
Regardless of the reasons, there were
numerous anecdotal arguments made during
the development of this report that encouraged
consideration of expanding services to include
civilian employees.
Recommendation 21. Encourage departments to
make support available to nonsworn employees on
the same terms as their sworn colleagues whenever
possible.
The civilian staff most often mentioned as
warranting enhanced services were dispatch,
forensic, and crime scene investigation staff. It was
argued that they engage in the same incidents that
cause stress for officers, just in a different capacity.
It was also stated that the inherent inability for
dispatchers to achieve situational closure for
the more stressful incidents they encounter is
a particular cause of challenges. Simply making
wellness programs available to these civilian staff
members may benefit their personal wellness as
well as overall agency operational readiness.
Whole health programs are the goal,
but there is no single approach
that will succeed everywhere
Throughout this report, the focus has primarily
been on mitigating mental health challenges
inherent to a career in law enforcement. However,
several of the experts consulted while developing
this report and during previous convenings on
officer safety and wellness saw mental health
challenges as part of the continuum of inherently
impactful aspects of a career in law enforcement.
Attendees at the October 2017 OSW Group
meeting discussed factors that endanger officers’
physical health. For example, they have little time
to eat during their shifts and their diets may suffer.
Shift work and overtime or the need to hold a
second job may lead to inadequate sleep. Poor
 4 0 L AW E N F O R C E M E N T M E N TA L H E A LT H A N D W E L L N E S S A C T
nutrition coupled with lack of exercise can lead to
obesity, diabetes, hypertension, and an increased
risk for cardiovascular disease. These risks exist
even before the emotional stress of the job is
added into the equation.
Recommendation 22. The development of programs
that promote whole health and officer resilience should
be the goal of the profession.
The mutual dependency of physical and mental
health is undeniable. In the case studies report,
we see repeated evidence that successful officer
wellness initiatives address a variety of physical
health conditions alongside mental wellness
components.81 In interviews, police physicians
reiterated several main areas of focus that should
be given high priority in every law enforcement
agency as the building blocks of officer resilience:
“Tactical trauma care. Law enforcement
agencies must have standardized equipment,
including trauma care kits, and training in
tactical trauma care such as hemorrhage
control. When an officer is shot or otherwise
falls victim to trauma, the first responder to the
scene is often a fellow officer.
Cardiac screening. The risk of heart disease
appears higher among police officers than the
general population and may be exacerbated
by the acute surge of adrenaline that officers
experience in critical incidents. When officers
are not in good physical health the job is
inherently more dangerous.
Fitness. Lack of fitness is a health risk for
officers and a liability for their agencies. Every
agency should promote fitness goals for all
of its officers. In addition, agencies should
consider a benefit or reward structure for those
who meet or exceed them.
Overweight and obesity. The risk of shift
work and having a sedentary job places law
enforcement officers at higher risk of being
overweight or obese, both of which increase
the risk of heart disease and stroke and make
the law enforcement officer less successful in
certain job related performance measures.
Emotional or mental health. On a daily basis,
law enforcement officers see small traumas
that, over time, can have as significant an
impact as a major incident. This can lead to
a higher risk of self-medicating behaviors
such as alcohol use.”82
The DoD and the VA clearly recognize the
connectedness of physical and mental health,
as together they provide a robust network of
integrated programs and services for our nation’s
active duty and reserve personnel, our veterans,
their spouses, and their children. These programs
include the spiritual and the secular, the preventive
and the reactive; they strive for as many points
of access to service as possible. This network
is built on the backbone of the TRICARE health
care system and continues to evolve in ways that
strive to reduce stigma, expand access, and meet
the unique mental health needs of our military
personnel and their families.
A similar array of evidence-based health, wellness,
stress reduction, and resilience programs needs to
be developed, supported by organizational leaders,
and encouraged within all agencies. One model
that agencies could be encouraged to look at is
Total Worker Health, which addresses many of the
issues experienced by officers as well as a litany
of other challenges faced by their families and the
public.83 When this interrelatedness of physical and
mental wellness is addressed by law enforcement
agencies, that holistic attention will lead to
healthier, more resilient officers.
Conclusion
Crisis lines, mental health checks, and peer and
family support programs can be key components
of effective law enforcement mental health and
wellness programs provided they are appropriately
researched and resourced.
Crisis lines are a promising part of the necessary
suite of services required to support and sustain
officer mental health and wellness. To be effective,
they should (1) be staffed whenever possible by
counselors with law enforcement experience,
(2) be staffed with counselors trained specifically
on the needs of law enforcement officers, (3) have
adequate privacy controls both to ensure collection
of good data and to protect the clients who call
for service, and (4) enable referral to vetted local
service providers for callers ready to engage with
interventions. In addition, they should be studied
aggressively so that the evidentiary basis for the
practice may be demonstrated.
While there is no universally accepted structure
for mental health check programs, examples
of programs that are believed to be effective do
exist throughout American law enforcement.
They are conducted using various approaches—
often based on the needs and interests of a
department, the culture of a department, a
department’s budget, the stance of prevailing
police unions, and other factors.
The beneficial effects of peer counseling in law
enforcement have been documented in studies
with both federal agents and police officers.84 And
key to the success of any peer support program is
providing appropriate training and ongoing support
and supervision for the peers. Careful identification
and selection procedures for peers are also crucial.
They need to be people in the agency whom other
officers will trust and view as understanding. And
they need to have links to mental and behavioral
health professionals to be able to provide a bridge
to more traditional care.
But even beyond these, some additional ideas from
the DoD and the VA experience could be replicated
in the law enforcement context. This report has
looked to highlight some of the possibilities, but we
do so recognizing that not every law enforcement
agency or community is going to be starting
from the same place. Interest in and support for
expanding programs and services and for exploring
comprehensive approaches to wellness are going
to be important going forward. Many DoD and
VA programs are supported behind the scenes
by networks of clinicians and service providers.
It is one thing to build the public campaign or the
resource page or call line and encourage officers
in crisis to use it. It is another thing to have a
network of trained professionals behind the
campaign, resource page, or call line where
those officers can be referred for ongoing,
affordable, and convenient care. And as the DoD and
VA demonstrate, none of this is possible without a
leadership mandate and broad agency support.
We would be remiss if we closed this report without
speaking to why law enforcement–specific care is
important and thank Congress for this opportunity to
address this critical need. As was mentioned in one
interview, “I don’t know of another workforce that
is more skeptical than cops,” and that for mental
health professionals working in this arena, “a cop
is going to size you up quick and you risk being
written off as . . . not able to understand the ‘real’
world they operate in.” This is not a criticism of law
enforcement officers; in fact, an ability to quickly
assess a situation is exactly what we train officers
to develop as a vital skill in keeping both themselves
and their communities safe. But it means many
practitioners we have spoken to have noted that
 4 2 L AW E N F O R C E M E N T M E N TA L H E A LT H A N D W E L L N E S S A C T
clinicians and behavioral health programs will only
get one chance to make a first impression. And
this perception is backed up by researchers who
have noted that for a program to be sustainable,
the focus needs to be on feasibility, acceptance
to law enforcement community members, and
attractiveness to providers.85
Put another way, ecological validity may be more
important than scientific efficacy. Or, real-world
perceptions are potentially more critical to program
acceptance than evaluative outcomes. The use of
law enforcement community–based participatory
research to identify, design, and evaluate programs
that support law enforcement wellness may very
well improve the chance of program acceptance
within the profession. And these efforts to
bring researchers and clinicians directly into
the world of law enforcement will only stand
to increase their understanding of the unique
nature of the job.
Congress clearly understands this important next
step of educating clinicians on the climate and
culture of law enforcement in order to increase
program and service acceptance. Section 3 of the
Law Enforcement Mental Health and Wellness Act
states that “the Attorney General, in coordination
with the Secretary of Health and Human Services
(HHS), shall develop resources to educate mental
health providers about the culture of Federal,
State, tribal, and local law enforcement agencies
and evidence-based therapies for mental health
issues common to Federal, State, local, and tribal
law enforcement officers.” The DOJ looks forward
to working with the HHS on this effort over the
coming year, along with continuing its many other
efforts to support the mental health and wellness
of our nation’s law enforcement officers. Increased
information and educational materials for agency
leaders and clinicians combined with increased
support for peer support, crisis lines, mental
health checks, and training as described in this
report will greatly improve the health and wellness
of the men and women who dedicate themselves
to the public safety of all our communities.
Appendix A. Recommendations
1. Support the creation of a public service
campaign around law enforcement officer mental
health and wellness in conjunction with National
Mental Health Month.
2. Support the development of resources for
community-based clinicians who interact with law
enforcement and their families to help them better
understand some of the unique risks facing their
clients and what resources may be available to them
as members of the first responder community.
3. Support programs to embed mental health
professionals in law enforcement agencies.
4. Support programs for law enforcement family
readiness at the federal, state, and local level.
5. Encourage departments to allow retired law
enforcement officers to make use of
departmental peer support programs for a select
period of time post-retirement or separation.
6. Support the development of model policies
and implementation guidance for law enforcement
agencies to make substantial efforts to
reduce suicide.
7. Support the creation of a Law Enforcement Suicide
Event Report surveillance system, possibly beginning
with a focus on federal law enforcement agencies.
8. Support rigorous research that can evaluate the
efficacy of crisis lines and, if supported, provide
data toward considering them an evidence-based
practice.
9. Support the expansion of crisis lines for law
enforcement that are staffed with call-takers and
counselors with a law enforcement background.
10. Consider support for a national crisis line for law
enforcement.
11. Support research to determine the efficacy of
mental health checks, establish which approaches
are most effective, and provide resources that
move law enforcement toward best practices.
12. Consider methods for establishing remote
access or regional mental health check programs at
the state or federal level.
13. Support the expansion of peer support
programs to ensure all officers have access to this
important wellness service.
14. Support the expansion of peer programs to
include broader health and wellness, not just
critical incident stress.
15. Support alternative models to agency
specific peer programs, such as through regional
collaborations or labor organizations.
16. Support training programs for peer mentors for
peer support programs to expand.
17. Remember all the types of agencies, including
federal, when supporting peer programs for
law enforcement.
18. Improve legislative privacy protections for
officers seeking assistance from peer crisis lines
and other peer-support programs.
19. Support the identification, development, and
delivery of successful resiliency training programs
for both academy and periodic in-service settings.
 4 4 L AW E N F O R C E M E N T M E N TA L H E A LT H A N D W E L L N E S S A C T

20. Support training programs that promote the 22. The development of programs that promote
universal application of preventive interventions, whole health and officer resilience should be the
including skills to manage stress. goal of the profession.

21. Encourage departments to make support

available to nonsworn employees on the same
terms as their sworn colleagues whenever
possible.
Appendix B. Abbreviations, Acronyms, and Initialisms
BJA Bureau of Justice Assistance

COPS Office Office of Community Oriented Policing Services

DHA Defense Health Agency

DHS U.S. Department of Homeland Security

DoD U.S. Department of Defense

DoDSER Department of Defense Suicide Event Report

DOJ U.S. Department of Justice

EAP employee assistance program

EBH embedded behavioral health

EMT emergency medical technician

FRG family readiness group

FY fiscal year

HHS U.S. Department of Health and Human Services

HIPAA Health Insurance Portability and Accountability Act

LEMHWA Law Enforcement Mental Health and Wellness Act

LEOKA Law Enforcement Officers Killed in Action

MCL Military Crisis Line

MHS Military Health System

NLEOMF National Law Enforcement Officers Memorial Fund

OSW Group Officer Safety and Wellness Group

PTSD post-traumatic stress disorder

SWAT special weapons and tactics

VA U.S. Department of Veterans Affairs

VALOR Violence Against Law Enforcement Officers and Ensuring Officer Resilience and
Survivability

VCL Veterans Crisis Line

VHB virtual hope box

Notes
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 Chapter  5 3
Good mental and psychological health is just as essential as good physical health for law enforcement
officers to be effective in keeping our country and our communities safe from crime and violence. With
the passage of the Law Enforcement Mental Health and Wellness Act, Congress took an important step
in improving the delivery of and access to mental health and wellness services that will help our nation’s
more than 800,000 federal, state, local, and tribal law enforcement officers. Many things, including
strong relationships with the community, help keep officers safe on the job. This act called for the U.S.
Department of Justice (DOJ) to submit a report to Congress on mental health practices and services in
the U.S. Departments of Defense and Veterans Affairs that could be adopted by federal, state, local, or
tribal law enforcement agencies and containing recommendations to Congress on effectiveness of crisis
lines for law enforcement officers, efficacy of annual mental health checks for law enforcement officers,
expansion of peer mentoring programs, and ensuring privacy considerations for these types of programs.
The DOJ is pleased to respond to this requirement of the act with this report.

U.S. Department of Justice

Office of Community Oriented Policing Services
145 N Street NE
Washington, DC 20530
To obtain details about COPS Office programs, call
the COPS Office Response Center at 800-421-6770.
Visit the COPS Office online at www.cops.usdoj.gov.

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Published 2019